Individual
SHANE MICHAEL DUTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1225 W BACALL ST, MERIDIAN, ID 83646-6388
(208) 407-8014
Mailing address
1225 W BACALL ST, MERIDIAN, ID 83646-6388
(208) 407-8014
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-5998
ID
Other
Enumeration date
08/22/2022
Last updated
08/22/2022
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