NPI 1336697366

Shane Weideman

Practitioner Mental Health Counselor Emmett, ID

Practice location

Address: 2007 E Quail Run Rd, Emmett, ID 83617-5059
Phone: (208) 365-5445
Mailing address: 2305 Valley View Dr, Weiser, ID 83672-1245

Registered specialties

Mental Health Counselor Primary

Behavioral Health & Social Service Providers Taxonomy 101YM0800X Licence LPC-6270 (ID)

Other Counselor providers in Idaho →

Registry record

NPI: 1336697366
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Sep 2016
Record last updated: 19 Sep 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.