Individual
JO ANNA SHOTIVEYARATANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
756 ASH ST, POCATELLO, ID 83201-6104
(208) 252-5087
Mailing address
756 ASH ST, POCATELLO, ID 83201-6104
(208) 252-5087
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-7837
ID
101YS0200X
School Counselor
LPC-7837
ID
Other
Enumeration date
10/13/2020
Last updated
01/09/2025
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