MEDICARE: SHONTAE CONE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC-7044	ID

General Provider Information

NPI Number	:	1033686217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHONTAE CONE

Provider Business Mailing Address
First Line	:	1120 S RACKHAM WAY STE 300
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-1092
Country	:	US
Telephone Number	:	208-789-0658
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 S RACKHAM WAY STE 300
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-1092
Country	:	US
Telephone Number	:	208-789-0658
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2018
Last Update Date	:	04/09/2026

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Directions to “ SHONTAE CONE ” Practice Location

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