Individual
MR. SHON LORIN SHULDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1277 E 17TH ST, IDAHO FALLS, ID 83404-6126
(208) 523-0787
(208) 523-3175
Mailing address
1301 E 17TH ST, STE 4, IDAHO FALLS, ID 83404-6273
(208) 523-0787
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW-28863
ID
1041C0700X
Clinical Social Worker
LCSW-28863
ID
Other
Enumeration date
04/15/2008
Last updated
06/20/2018
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