Shane M Clubb, M.A., L.C.P.C.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LCPC-3989 Issued in ID

Practice address

39 E State Ave
Meridian, ID 83642-2342

Phone

(208) 994-3599

Fax

(208) 473-2206

NPI assigned

Mar 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

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

• Perspectives Counseling

  • Professional Counselor
  • Boise, ID
  • NPI 1952723462
  NPD (past) Authorized official

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355097600000",
    "number": "1871554584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 E STATE AVE",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422342",
            "telephone_number": "208-994-3599",
            "fax_number": "208-473-2206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 E STATE AVE",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422342",
            "telephone_number": "208-994-3599",
            "fax_number": "208-473-2206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLUBB",
        "first_name": "SHANE",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "M.A., L.C.P.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2012-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "LCPC-3989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Werner Cleveland, PHARM.D.
• Jami Clevenger, LCPC
• Corinne Kathleen Cleverly, AU.D. CCC-A, F-AA
• Martha A Cline, MD
• Paige W Cline, PA-C
• Travis Clyde, M.D.
• CNC, Inc.
• Wendy I Coffman, LCSW
• Cognitive Solutions, PLLC
• Tobias Colburn, DPT

• Mental Health Counselor in Meridian, ID
• Providers in Meridian, ID by specialty
• Mental Health Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2012; 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.