Provider Demographics
NPI:1447608039
Name:FLETCHER, SHANNA LYN (MA, LMFTA)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:LYN
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:MA, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 257
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-0257
Mailing Address - Country:US
Mailing Address - Phone:360-250-9114
Mailing Address - Fax:
Practice Address - Street 1:324 WEST BAY DR NW
Practice Address - Street 2:SUITE 212A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4926
Practice Address - Country:US
Practice Address - Phone:360-250-9114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA475328566OtherEIN