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Individual

MR. SHAWN ROBERT ISRAELSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
2265 W BROADWAY ST, IDAHO FALLS, ID 83402-2996
(208) 524-7400
(208) 534-8004
Mailing address
2275 W. BROADWAY ST #G, IDAHO FALLS, ID 83402-2902
(208) 524-7400
(208) 524-8004

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LCSW-44276
ID
104100000X
Social Worker
LMSW-18733
AZ
104100000X
Social Worker
LMSW-40331
ID
1041C0700X
Clinical Social Worker
8722060-3502
UT
1041C0700X
Clinical Social Worker
8722060-3502CSW
UT

Other

Enumeration date
11/03/2020
Last updated
10/18/2023
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