Provider Demographics
NPI:1104840438
Name:SUNSHAW, EMMA MARIE (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:EMMA
Middle Name:MARIE
Last Name:SUNSHAW
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 S CAROL ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1839
Mailing Address - Country:US
Mailing Address - Phone:208-994-5343
Mailing Address - Fax:
Practice Address - Street 1:1560 S CAROL ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1839
Practice Address - Country:US
Practice Address - Phone:208-994-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK03955101YM0800X
UT11743380-6004101YM0800X
ID9059101YM0800X
KS2629101YM0800X
NJ37PC00927400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158951719Medicaid
AR06010014900OtherQUALCHOICE PROVIDER #
OK200387180AMedicaid
AR9421291OtherPHCS PROVIDER #
AR5Y679OtherBLUE CROSS PROVIDER #