Provider Demographics
NPI:1376111211
Name:HASENOEHRL, SHELBY (LPC)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:HASENOEHRL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:822 BRYDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4928
Mailing Address - Country:US
Mailing Address - Phone:208-984-9794
Mailing Address - Fax:
Practice Address - Street 1:822 BRYDEN AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4928
Practice Address - Country:US
Practice Address - Phone:208-984-9794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC8280101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional