Provider Demographics
NPI:1518181395
Name:SHOHET, KRISTI LYNN (MS, LCPC)
Entity type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:LYNN
Last Name:SHOHET
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 S BRENTBROOK LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-4899
Mailing Address - Country:US
Mailing Address - Phone:208-939-5553
Mailing Address - Fax:208-288-5779
Practice Address - Street 1:612 S BRENTBROOK LN
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-4899
Practice Address - Country:US
Practice Address - Phone:208-939-5553
Practice Address - Fax:208-288-5779
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC4172101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010148813OtherREGENCE BLUE SHIELD
ID806968300Medicaid
ID8N639OtherBLUE CROSS OF IDAHO