Individual
MR. SHANE M CLUBB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A., L.C.P.C.
Contact information
Practice address
39 E STATE AVE, MERIDIAN, ID 83642-2342
(208) 994-3599
(208) 473-2206
Mailing address
39 E STATE AVE, MERIDIAN, ID 83642-2342
(208) 994-3599
(208) 473-2206
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-3989
ID
Other
Enumeration date
03/31/2006
Last updated
12/10/2012
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