Provider Demographics
NPI:1932501483
Name:SHAH, MUNIR WESLEY (MA)
Entity Type:Individual
Prefix:MR
First Name:MUNIR
Middle Name:WESLEY
Last Name:SHAH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:MATTHEW
Other - Middle Name:WESLEY
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:900 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2005
Mailing Address - Country:US
Mailing Address - Phone:509-758-3341
Mailing Address - Fax:
Practice Address - Street 1:900 7TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2005
Practice Address - Country:US
Practice Address - Phone:509-758-3341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60503791101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health