Provider Demographics
NPI:1669249041
Name:KRISTEN SHEARER LLC
Entity type:Organization
Organization Name:KRISTEN SHEARER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEARER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:208-830-9027
Mailing Address - Street 1:1204 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4115
Mailing Address - Country:US
Mailing Address - Phone:208-830-9027
Mailing Address - Fax:
Practice Address - Street 1:410 S ORCHARD ST STE 160
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1295
Practice Address - Country:US
Practice Address - Phone:208-352-6018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty