Provider Demographics
NPI:1508158148
Name:WHITE, SHELLEY BAKER (MA)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:BAKER
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20102 CEDAR VALLEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6333
Mailing Address - Country:US
Mailing Address - Phone:360-509-2812
Mailing Address - Fax:
Practice Address - Street 1:20102 CEDAR VALLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6333
Practice Address - Country:US
Practice Address - Phone:360-509-2812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60161602101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health