Provider Demographics
NPI:1295038800
Name:KENZLER OLMSTEAD, SHANA RENE (MA, LMHCA)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:RENE
Last Name:KENZLER OLMSTEAD
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8237 NE 110TH PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3546
Mailing Address - Country:US
Mailing Address - Phone:206-799-0936
Mailing Address - Fax:
Practice Address - Street 1:3310 E LAKE SAMMAMISH PKWY SE
Practice Address - Street 2:#1
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-7497
Practice Address - Country:US
Practice Address - Phone:425-677-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60194097101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health