Provider Demographics
NPI:1194201368
Name:SHEAHAN, MARK D (MS, CAAR, LMHC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:SHEAHAN
Suffix:
Gender:M
Credentials:MS, CAAR, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19120 SE 34TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-1430
Mailing Address - Country:US
Mailing Address - Phone:971-380-4283
Mailing Address - Fax:
Practice Address - Street 1:19120 SE 34TH ST STE 201
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1430
Practice Address - Country:US
Practice Address - Phone:971-380-4283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61061856101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2107636Medicaid