Provider Demographics
NPI: | 1023435781 |
---|---|
Name: | SHELLY HUFFMAN, MA, LMHC |
Entity type: | Organization |
Organization Name: | SHELLY HUFFMAN, MA, LMHC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SOLE PROPRIETOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SHELLY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HUFFMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MA, LMHC |
Authorized Official - Phone: | 425-205-3018 |
Mailing Address - Street 1: | 600 1ST AVE STE 526 |
Mailing Address - Street 2: | |
Mailing Address - City: | SEATTLE |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98104-2214 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 600 1ST AVE STE 526 |
Practice Address - Street 2: | |
Practice Address - City: | SEATTLE |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98104-2214 |
Practice Address - Country: | US |
Practice Address - Phone: | 425-205-3018 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-03-19 |
Last Update Date: | 2014-03-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | 60076692 | 101YM0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |