Provider Demographics
NPI:1275297228
Name:STEIN, SHANNON MARISSA (LMHCA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARISSA
Last Name:STEIN
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:STEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHCA
Mailing Address - Street 1:13280 LINDEN AVE N APT 719
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-7649
Mailing Address - Country:US
Mailing Address - Phone:425-477-9118
Mailing Address - Fax:
Practice Address - Street 1:13280 LINDEN AVE N APT 719
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-7649
Practice Address - Country:US
Practice Address - Phone:425-477-9118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61201477101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health