Provider Demographics
NPI:1891319216
Name:KNIGHT, SHANNON (LMHCA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19689 7TH AVE NE # 110
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8091
Mailing Address - Country:US
Mailing Address - Phone:360-830-6617
Mailing Address - Fax:360-830-6617
Practice Address - Street 1:2625 WHEATON WAY STE B
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3372
Practice Address - Country:US
Practice Address - Phone:360-792-2020
Practice Address - Fax:360-478-6993
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61262511101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health