Provider Demographics
NPI:1902567605
Name:SPANGLER, SHELBY ANN (LPC)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:ANN
Last Name:SPANGLER
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 1:7950 N HORSESHOE BEND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-3809
Mailing Address - Country:US
Mailing Address - Phone:208-477-7291
Mailing Address - Fax:
Practice Address - Street 1:7950 N HORSESHOE BEND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-3809
Practice Address - Country:US
Practice Address - Phone:208-477-7291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-02-17
Deactivation Date:2022-01-12
Deactivation Code:
Reactivation Date:2022-02-17
Provider Licenses
StateLicense IDTaxonomies
ID8503101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional