Provider Demographics
NPI:1659783413
Name:STEPHENS, SHILOH (LPC)
Entity Type:Individual
Prefix:
First Name:SHILOH
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 E 2ND N
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-2711
Mailing Address - Country:US
Mailing Address - Phone:208-587-8095
Mailing Address - Fax:208-587-8025
Practice Address - Street 1:140 E 2ND N
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-2711
Practice Address - Country:US
Practice Address - Phone:208-587-8095
Practice Address - Fax:208-587-8025
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5554101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor