Provider Demographics
NPI:1841680410
Name:HUFFMAN, SHELLY (MA)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8934 SANDS AVE NE UNIT B
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1634
Mailing Address - Country:US
Mailing Address - Phone:206-823-9128
Mailing Address - Fax:
Practice Address - Street 1:785 ERICKSEN AVE NE STE 117
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1874
Practice Address - Country:US
Practice Address - Phone:206-823-9128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60076692101YM0800X
TX72811101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health