Provider Demographics
NPI:1831711100
Name:STAUFFER, SHANNON E (LMHC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:E
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 112TH DR NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-8408
Mailing Address - Country:US
Mailing Address - Phone:206-257-8777
Mailing Address - Fax:
Practice Address - Street 1:2804 GRAND AVE STE 304
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3586
Practice Address - Country:US
Practice Address - Phone:206-659-8775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-10
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60580331101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional