Provider Demographics
NPI:1972517654
Name:CARSON, SHELLEY S (LPC)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:S
Last Name:CARSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:211 16TH AVE N
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83653-0009
Mailing Address - Country:US
Mailing Address - Phone:208-467-4431
Mailing Address - Fax:208-467-7684
Practice Address - Street 1:1224 1ST ST S
Practice Address - Street 2:STE 103
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-3900
Practice Address - Country:US
Practice Address - Phone:208-463-2314
Practice Address - Fax:208-463-4390
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDLPC3262101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional