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1871554584
SHANE M CLUBB
MERIDIAN, ID
NPI
1871554584
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor Mental Health
(Licence: ID LCPC-3989)
Enumeration Date
2006-03-31
Last Update Date
2012-12-10
Business Address
MR. SHANE M CLUBB M.A., L.C.P.C.
39 E STATE AVE
MERIDIAN, ID 83642-2342
Phone number: 208-994-3599
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Mailing Address
MR. SHANE M CLUBB M.A., L.C.P.C.
39 E STATE AVE
MERIDIAN, ID 83642-2342
Phone number: 208-994-3599
Copy
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