Provider Demographics
NPI:1801068127
Name:BRILEY, SHAWN JOYCE (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHAWN
Middle Name:JOYCE
Last Name:BRILEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:208-634-2979
Mailing Address - Fax:
Practice Address - Street 1:321 N 3RD ST
Practice Address - Street 2:SUITE 11
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:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-288261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical