Clubb, Shane M

Clubb, Shane M is an individual health care provider with primary practice located at 39 E State Ave , Meridian ID 83642-2342. He recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as his primary health care specialty. Clubb, Shane M can be contacted via phone (208) 994-3599.

Contact Information

Primary practice address
39 E State Ave Meridian ID 83642-2342
Phone: (208) 994-3599
Fax: (208) 473-2206
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X LCPC-3989 Idaho

Profile Details

NPI number 1871554584
LBN Legal business name Clubb, Shane M
Credentials M.A., L.C.P.C.
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 31st, 2006
Last updated Dec 10th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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