Provider Demographics
NPI:1336587880
Name:ERICSON, SHAUNA M (MHP, LMHC, CMHS)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:M
Last Name:ERICSON
Suffix:
Gender:F
Credentials:MHP, LMHC, CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6004 CAPITOL BLVD SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-8520
Mailing Address - Country:US
Mailing Address - Phone:360-704-7580
Mailing Address - Fax:360-704-7567
Practice Address - Street 1:6004 CAPITOL BLVD SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-8520
Practice Address - Country:US
Practice Address - Phone:360-704-7580
Practice Address - Fax:360-704-7567
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60314421101YM0800X
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health