Provider Demographics
NPI:1336138106
Name:SHULL, FRANK E (MED LCPC)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:E
Last Name:SHULL
Suffix:
Gender:M
Credentials:MED LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501
Mailing Address - Country:US
Mailing Address - Phone:208-790-3083
Mailing Address - Fax:208-798-7177
Practice Address - Street 1:1630 23RD AVE
Practice Address - Street 2:BLDG 301
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501
Practice Address - Country:US
Practice Address - Phone:208-790-3083
Practice Address - Fax:208-798-7177
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004257101YM0800X
IDLCPC3102101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID05191OtherBLUE CROSS OF ID
ID000010147555OtherREGENCE BLUE SHIELD OF ID