Provider Demographics
NPI:1720552805
Name:SHREVE, DOROTHY ELLEN (LMFT, LMHCA)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:ELLEN
Last Name:SHREVE
Suffix:
Gender:F
Credentials:LMFT, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 20TH ST APT A2
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-8159
Mailing Address - Country:US
Mailing Address - Phone:408-806-1492
Mailing Address - Fax:
Practice Address - Street 1:3350 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8048
Practice Address - Country:US
Practice Address - Phone:360-734-5458
Practice Address - Fax:360-734-5298
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110809106H00000X
WAMC61146676101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist