Shade, Marie Ann
Shade, Marie Ann is an individual health care provider with primary practice located at 684 N 9Th Street , Boise ID 85702-5458. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is her primary health care specialty. Shade, Marie Ann can be contacted via phone (208) 343-6636.Contact Information
Primary practice address
684 N 9Th Street
Boise ID 85702-5458
Phone: (208) 343-6636
Fax: (208) 389-1474
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | LCPC44 | Idaho |
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | LCPC44 | Idaho |
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | LCPC44 | Idaho |
Profile Details
| NPI number | 1609945831 |
|---|---|
| LBN Legal business name | Shade, Marie Ann |
| Credentials | LCPC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 6th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1609945831 | NPPES |
| Idaho | Other | Q1687 | BLUE CROSS |
| Idaho | Other | 000010016630 | BLUE CROSS |
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