Provider Demographics
NPI:1154867729
Name:VONBARGEN, SHAWN (MAMFT, LMHC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:VONBARGEN
Suffix:
Gender:M
Credentials:MAMFT, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 RW JOHNSON ROAD SW
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512
Mailing Address - Country:US
Mailing Address - Phone:253-655-7586
Mailing Address - Fax:
Practice Address - Street 1:2510 RW JOHNSON ROAD SW
Practice Address - Street 2:SUITE # 102
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512
Practice Address - Country:US
Practice Address - Phone:253-655-7586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60728380101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health