Provider Demographics
NPI:1225699226
Name:SHATTUCK, LLOYD EMSLEY (CDP)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:EMSLEY
Last Name:SHATTUCK
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13037 NE BEL RED RD STE 102A
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2651
Mailing Address - Country:US
Mailing Address - Phone:425-502-9945
Mailing Address - Fax:425-698-1541
Practice Address - Street 1:13037 NE BEL RED RD STE 102A
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2651
Practice Address - Country:US
Practice Address - Phone:425-502-9945
Practice Address - Fax:425-698-1541
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60433542101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)