Provider Demographics
NPI:1437848868
Name:SHAZIER, LOVETT
Entity Type:Individual
Prefix:
First Name:LOVETT
Middle Name:
Last Name:SHAZIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9609 96TH CT NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-6712
Mailing Address - Country:US
Mailing Address - Phone:737-256-9551
Mailing Address - Fax:
Practice Address - Street 1:9609 96TH CT NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-6712
Practice Address - Country:US
Practice Address - Phone:737-256-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61417283106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician