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General NPI Number Information
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NPI Number | 1669249041
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Entity Type | Organization
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Legal Business Name | KRISTEN SHEARER LLC
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Dates
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Enumeration Date | 12/06/2023
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 410 S ORCHARD ST STE 160
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City | BOISE
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State | ID
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Zip | 83705-1295
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Country | US
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Telephone | 208-352-6018
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Fax |
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Provider Business Mailing Address
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Address Line | 1204 N 13TH ST
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City | BOISE
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State | ID
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Zip | 83702-4115
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Country | US
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Telephone | 208-830-9027
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | KRISTEN SHEARER
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Credential | LPC
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Telephone | 208-830-9027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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