Individual
MS. SHAWNA EDDY EDDY KISSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYCHOLOGIST, LCPC
Contact information
Practice address
541 W 3RD ST, WEISER, ID 83672-1813
(208) 549-0995
Mailing address
541 W 3RD ST, WEISER, ID 83672-1813
(208) 549-0995
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC
ID
103T00000X
Psychologist
5061
OR
103T00000X
Psychologist
PS007800L
PA
Other
Enumeration date
06/10/2020
Last updated
06/10/2020
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