Provider Demographics
NPI:1275645418
Name:SHETLER, JOYCE IRENE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:IRENE
Last Name:SHETLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 FALLS AVE
Mailing Address - Street 2:SUITE 1020M
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301
Mailing Address - Country:US
Mailing Address - Phone:208-734-0611
Mailing Address - Fax:208-734-5354
Practice Address - Street 1:834 FALLS AVE
Practice Address - Street 2:SUITE 1020M
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301
Practice Address - Country:US
Practice Address - Phone:208-734-0611
Practice Address - Fax:208-734-5354
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW4181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDL4181OtherBLUE CROSS
ID000010015893OtherREGENCE BLUE SHIELD