Provider Demographics
NPI:1295373330
Name:GALBRAITH, SHANA (LPC)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:GALBRAITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 E 17TH ST STE 208
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8048
Mailing Address - Country:US
Mailing Address - Phone:208-932-0668
Mailing Address - Fax:
Practice Address - Street 1:1970 E 17TH ST STE 208
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8048
Practice Address - Country:US
Practice Address - Phone:208-932-0668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7508101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health