Provider Demographics
NPI:1821785734
Name:MALIK, SHELLY (CL)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:
Last Name:MALIK
Suffix:
Gender:F
Credentials:CL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13401 SE 59TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-4119
Mailing Address - Country:US
Mailing Address - Phone:425-465-5045
Mailing Address - Fax:
Practice Address - Street 1:4540 SAND POINT WAY NE STE 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3941
Practice Address - Country:US
Practice Address - Phone:206-575-8880
Practice Address - Fax:206-517-4491
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL61423174101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor