Shawn Robert Israelsen, LCSW

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LCSW-44276 Issued in ID

Practice address

2265 W Broadway St
Idaho Falls, ID 83402-2996

Phone

(208) 524-7400

Fax

(208) 534-8004

NPI assigned

Nov 3, 2020

Last updated

Oct 18, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Tueller Counseling IncGroup PAC ID 0547585895, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tueller Counseling Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Idaho Falls, ID
  • NPI 1477766905
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1604361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697587200000",
    "number": "1629679048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2275 W. BROADWAY ST #G",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834022902",
            "telephone_number": "208-524-7400",
            "fax_number": "208-524-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2265 W BROADWAY ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834022996",
            "telephone_number": "208-524-7400",
            "fax_number": "208-534-8004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISRAELSEN",
        "first_name": "SHAWN",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-03",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ID",
            "license": "LCSW-44276",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AZ",
            "license": "LMSW-18733",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ID",
            "license": "LMSW-40331",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "8722060-3502",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "8722060-3502CSW",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Intermountain Regenerative Medicine
• Intrinsic Holdings Corp
• Invictus RX PLLC
• R. Douglas Isbell, M.D.
• Jessica Ashley Isom
• Emily Joanne Iund
• Heath Richard Ivers, BCBA
• Ivie Family Vision PA
• Jared Reese Ivie, O.D.
• Laura Ivie, PA-C

• Professional Counselor in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Professional Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.