Provider Demographics
NPI:1013122696
Name:WEST, SHANNON RENAE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:RENAE
Last Name:WEST
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11335 NE 122ND WAY
Mailing Address - Street 2:STE 105
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6933
Mailing Address - Country:US
Mailing Address - Phone:425-414-7465
Mailing Address - Fax:
Practice Address - Street 1:11335 NE 122ND WAY
Practice Address - Street 2:STE 105
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6933
Practice Address - Country:US
Practice Address - Phone:425-414-7465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WALF00002571106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor