Provider Demographics
NPI:1033686217
Name:CONE, SHONTAE
Entity type:Individual
Prefix:
First Name:SHONTAE
Middle Name:
Last Name:CONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 W BLOOM ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-3601
Mailing Address - Country:US
Mailing Address - Phone:208-830-0791
Mailing Address - Fax:
Practice Address - Street 1:856 BANKS LOWMAN RD
Practice Address - Street 2:
Practice Address - City:GARDEN VALLEY
Practice Address - State:ID
Practice Address - Zip Code:83622-8102
Practice Address - Country:US
Practice Address - Phone:208-462-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7044101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor