Provider Demographics
NPI:1851912265
Name:SHALLAHAMER, ANNALISA (MA, NCC, LPC-INTERN)
Entity Type:Individual
Prefix:
First Name:ANNALISA
Middle Name:
Last Name:SHALLAHAMER
Suffix:
Gender:F
Credentials:MA, NCC, LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 SNIDOW DR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4349
Mailing Address - Country:US
Mailing Address - Phone:503-799-9771
Mailing Address - Fax:
Practice Address - Street 1:5440 SW WESTGATE DR STE 210
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2418
Practice Address - Country:US
Practice Address - Phone:503-837-8423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR5787101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health