Provider Demographics
NPI:1649710153
Name:CLAY, SHANNON (MS MHP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:CLAY
Suffix:
Gender:F
Credentials:MS MHP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:MCLEOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS MHP
Mailing Address - Street 1:1007 KOALA AVE
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-9247
Mailing Address - Country:US
Mailing Address - Phone:509-826-6191
Mailing Address - Fax:509-826-3029
Practice Address - Street 1:1007 KOALA AVE
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9247
Practice Address - Country:US
Practice Address - Phone:509-826-6191
Practice Address - Fax:509-826-3029
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60542705101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health