Provider Demographics
NPI:1407617723
Name:NEIMAN, SHELBY (MC 61474120)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:NEIMAN
Suffix:
Gender:F
Credentials:MC 61474120
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 S CEDAR ST STE G
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-5702
Mailing Address - Country:US
Mailing Address - Phone:253-426-8773
Mailing Address - Fax:
Practice Address - Street 1:2732 GRAND AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3416
Practice Address - Country:US
Practice Address - Phone:253-426-8773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61511118101YA0400X
WAMC61474120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)