Provider Demographics
NPI:1376965509
Name:PARMANAND, SHAWN PETER (LCPC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:PETER
Last Name:PARMANAND
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 E TERRY ST
Mailing Address - Street 2:BLDG 63
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83209-8120
Mailing Address - Country:US
Mailing Address - Phone:208-960-0452
Mailing Address - Fax:208-282-2583
Practice Address - Street 1:1440 E TERRY ST
Practice Address - Street 2:BLDG 63
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83209-8120
Practice Address - Country:US
Practice Address - Phone:208-960-0452
Practice Address - Fax:208-282-2583
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC3941101YM0800X
IDLCPC-6743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLPC-3914OtherSTATE OF IDAHO