Individual
MR. MICHAEL SHANE OLDFIELD I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
2420 E 25TH ST, IDAHO FALLS, ID 83404-7549
(208) 542-1026
Mailing address
2420 E 25TH ST, IDAHO FALLS, ID 83404-7549
(208) 542-1026
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
29470
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29470
MASTERS OF SOCIAL WORKER IDAHO STATE LICENSE NUMBER (LMSW)
ID
Enumeration date
08/24/2009
Last updated
08/24/2009
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