Provider Demographics
NPI:1306000328
Name:KING, SHANNON C (MA LMHC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:C
Last Name:KING
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 ALDER AVE
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-1406
Mailing Address - Country:US
Mailing Address - Phone:253-227-3222
Mailing Address - Fax:253-891-1044
Practice Address - Street 1:918 ALDER AVE
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1406
Practice Address - Country:US
Practice Address - Phone:253-227-3222
Practice Address - Fax:253-891-1044
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011178101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health