Provider Demographics
NPI:1376183541
Name:SHAFF, MONICA MARIE (BAS, CADC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:MARIE
Last Name:SHAFF
Suffix:
Gender:F
Credentials:BAS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 EASTGLEN WAY
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-7671
Mailing Address - Country:US
Mailing Address - Phone:208-734-4200
Mailing Address - Fax:208-734-1404
Practice Address - Street 1:1102 EASTGLEN WAY
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-7671
Practice Address - Country:US
Practice Address - Phone:208-734-4200
Practice Address - Fax:208-734-1404
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID11800101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)