Individual
SHANE ALAN THOMASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
2596 N STOKESBERRY PL, MERIDIAN, ID 83646-6114
(208) 918-1636
Mailing address
5434 N ISLA AVE, MERIDIAN, ID 83646-5852
(208) 405-9165
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-5755
ID
Other
Enumeration date
12/16/2014
Last updated
08/19/2024
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