Individual
SUSAN KELLI SHAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1655 W FAIRVIEW AVE STE 209, BOISE, ID 83702-5190
(208) 352-0343
Mailing address
1655 W FAIRVIEW AVE STE 209, BOISE, ID 83702-5190
(208) 352-0343
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
08/04/2025
Last updated
08/04/2025
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