Individual
MS. SHAUN L PHOENIX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
17 S 5TH AVE, BOZEMAN, MT 59715-4443
(406) 580-0562
Mailing address
112 LITTLE BROOK LN, BELGRADE, MT 59714-9533
(406) 580-0562
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
914
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000252518
—
MT
05
—
1982760625
—
MT
Enumeration date
12/28/2006
Last updated
12/26/2012
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