Provider Demographics
NPI:1184968091
Name:AGUIRRE, SHAYNE M (LPC, NCC, QSUDP)
Entity type:Individual
Prefix:
First Name:SHAYNE
Middle Name:M
Last Name:AGUIRRE
Suffix:
Gender:M
Credentials:LPC, NCC, QSUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-2015
Mailing Address - Country:US
Mailing Address - Phone:208-568-1398
Mailing Address - Fax:
Practice Address - Street 1:120 S 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-1627
Practice Address - Country:US
Practice Address - Phone:208-245-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4990101YA0400X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional