Provider Demographics
NPI:1033802988
Name:LEY, SHIRLEY JUAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:JUAN
Last Name:LEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4722 RAINIER AVE S UNIT 328
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2079
Mailing Address - Country:US
Mailing Address - Phone:360-842-3832
Mailing Address - Fax:
Practice Address - Street 1:338 NW 85TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-3120
Practice Address - Country:US
Practice Address - Phone:206-659-5945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3217103T00000X
NY024789103T00000X
WAPY61444441103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist