Individual
SHANE RYAN KELSEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LPC
Contact information
Practice address
531 E 5TH ST, BURLEY, ID 83318-1469
(208) 678-3555
(208) 678-3556
Mailing address
622 DETTERS RD, TWIN FALLS, ID 83301-4991
(208) 219-2378
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-8949
ID
Other
Enumeration date
06/28/2022
Last updated
06/28/2022
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