Provider Demographics
NPI:1356490478
Name:THOMPSON, SHANNON KATHLEEN (LH)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:KATHLEEN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33442 1ST WAY S
Mailing Address - Street 2:STE 101
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6210
Mailing Address - Country:US
Mailing Address - Phone:253-320-3020
Mailing Address - Fax:253-486-1902
Practice Address - Street 1:33442 1ST WAY S
Practice Address - Street 2:STE 101
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6210
Practice Address - Country:US
Practice Address - Phone:253-320-3020
Practice Address - Fax:253-486-1902
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60106650101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2024997Medicaid