Provider Demographics
NPI:1417329624
Name:MINSHALL, MEGHAN EILEEN (LPC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:EILEEN
Last Name:MINSHALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:LIGHTFOOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 DEINHARD LN
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-4703
Practice Address - Country:US
Practice Address - Phone:208-630-2450
Practice Address - Fax:208-634-4055
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5815101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional