Individual
SHANA L STUBBLEFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
611 HOOPES AVE, IDAHO FALLS, ID 83401-6106
(208) 557-7500
Mailing address
2415 EASTVIEW DR, IDAHO FALLS, ID 83401-3319
(208) 917-0561
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
35214
ID
Other
Enumeration date
06/28/2016
Last updated
06/28/2016
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