Provider Demographics
NPI:1023783479
Name:SHAVER-FOX, KATHRYN KAY (LMSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:KAY
Last Name:SHAVER-FOX
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 W OVERLAND RD STE 301
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-3077
Mailing Address - Country:US
Mailing Address - Phone:208-801-6806
Mailing Address - Fax:208-694-6301
Practice Address - Street 1:6003 W OVERLAND RD STE 301
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-3077
Practice Address - Country:US
Practice Address - Phone:208-801-6806
Practice Address - Fax:208-694-6301
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-40051101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health