Provider Demographics
NPI:1609027192
Name:SHAWN BRILEY COUNSELING LLC
Entity Type:Organization
Organization Name:SHAWN BRILEY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-455-1400
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:COUNCIL
Mailing Address - State:ID
Mailing Address - Zip Code:83612-0455
Mailing Address - Country:US
Mailing Address - Phone:208-455-1400
Mailing Address - Fax:
Practice Address - Street 1:321 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-4439
Practice Address - Country:US
Practice Address - Phone:208-634-2979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-288261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8N545OtherBLUE CROSS