Individual
LISA H SHINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
205 NORTH BERKLEY AVE, COUNCIL, ID 83612
(208) 253-4242
(208) 253-6849
Mailing address
PO BOX 428, COUNCIL, ID 83612-0428
(208) 253-4242
(208) 253-6849
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-26258
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LMSW-26258
STATE OF IDAHO
ID
Enumeration date
12/21/2007
Last updated
12/21/2007
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