MEDICARE: SHADOW RIVER COUNSELING PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1427908599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHADOW RIVER COUNSELING PLLC

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	ST MARIES
State	:	ID
Zip	:	83861-0307
Country	:	US
Telephone Number	:	208-261-2543
Fax Number	:	208-423-0345

Provider Business Practice Location Address
First Line	:	618 W COLLEGE AVE STE 1
Second Line	:
City	:	ST MARIES
State	:	ID
Zip	:	83861-5010
Country	:	US
Telephone Number	:	202-082-6125
Fax Number	:	208-423-0345

Authorized Official
Title or Position	:	CLINICIAN
Name	:	ASHLEY MILNER
Credential	:	LCSW
Telephone Number	:	208-261-2543

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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