Provider Demographics
NPI:1043737091
Name:SHANER, DORI A (LPC)
Entity type:Individual
Prefix:
First Name:DORI
Middle Name:A
Last Name:SHANER
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 1:6684 S LIVEOAK PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-5047
Mailing Address - Country:US
Mailing Address - Phone:208-409-4961
Mailing Address - Fax:
Practice Address - Street 1:6684 S LIVEOAK PL
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-5047
Practice Address - Country:US
Practice Address - Phone:208-409-4961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health