Individual
MRS. SHANTAL LEE LAULU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC, CADC
Contact information
Practice address
110 S 19TH AVE, POCATELLO, ID 83201-3312
(208) 234-4722
Mailing address
110 S 19TH AVE, POCATELLO, ID 83201-3312
(208) 234-4722
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-5335
ID
Other
Enumeration date
09/26/2013
Last updated
09/26/2013
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