Family Life Counseling Center LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

FAMILY LIFE COUNSELING CENTER LLC

Doing business as

Family Life Counseling Center

Practice address

1159 E Iron Eagle Dr Ste 170
Eagle, ID 83616-6870

Phone

(208) 407-8014

NPI assigned

Dec 5, 2023

Last updated

Jan 16, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shane Michael Duty, LCPCNPI 1295454544

Title

President

Phone

(208) 407-8014

Specialties & licenses 1

Addresses

Other names 1

• Family Life Counseling Center Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shane Michael Duty, LPC

  • Professional Counselor
  • Meridian, ID
  • NPI 1295454544
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705363200000",
    "number": "1154198786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1159 E IRON EAGLE DR STE 170",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166870",
            "telephone_number": "208-407-8014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1159 E IRON EAGLE DR STE 170",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166870",
            "telephone_number": "208-407-8014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY LIFE COUNSELING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-05",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A",
        "authorized_official_last_name": "DUTY",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-407-8014",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Life Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Life Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Professional Counselor in Eagle, ID
• Providers in Eagle, ID by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.