Active NPI
Marie Ann Shade, LCPC
- Addiction (Substance Use Disorder) Counselor
- Boise, ID
National Provider Identifier
1609945831
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- LCPC44
- Practice address
- 684 N 9TH Street
Boise, ID 85702-5458 - Phone
- (208) 343-6636
- Fax
- (208) 389-1474
- NPI assigned
- Nov 6, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LCPC44 | ID | Primary |
| Mental Health Counselor | 101YM0800X | LCPC44 | ID | |
| Professional Counselor | 101YP2500X | LCPC44 | ID |
Addresses
Primary practice location
684 N 9TH Street
Boise, ID 85702-5458
Mailing address
684 N 9TH Street
Boise, ID 85702-5458
Phone (208) 343-6636
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q1687 | Other | ID | BLUE CROSS |
| 000010016630 | Other | ID | REGENCE BLUE SHIELD |
Other names 1
- Marie A Shade
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCPC44 | ID | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1609945831",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "684 N 9TH STREET",
"city": "BOISE",
"state": "ID",
"postal_code": "857025458",
"telephone_number": "208-343-6636",
"fax_number": "208-389-1474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "684 N 9TH STREET",
"city": "BOISE",
"state": "ID",
"postal_code": "857025458",
"telephone_number": "208-343-6636",
"fax_number": "208-389-1474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHADE",
"first_name": "MARIE",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-06",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "ID",
"license": "LCPC44",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ID",
"license": "LCPC44",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": "LCPC44",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "Q1687",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "000010016630",
"state": "ID"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MARIE",
"last_name": "SHADE",
"middle_name": "A",
"credential": "LCPC",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.