Provider Demographics
NPI:1093094377
Name:SHAUB, JOSEPH ALLEN (MA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ALLEN
Last Name:SHAUB
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10940 NE 33RD PL
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1432
Mailing Address - Country:US
Mailing Address - Phone:206-587-0417
Mailing Address - Fax:
Practice Address - Street 1:10940 NE 33RD PL
Practice Address - Street 2:SUITE 109
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1432
Practice Address - Country:US
Practice Address - Phone:206-587-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF 00001567106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist