Provider Demographics
NPI:1932254992
Name:RICH, SHAUN ANTHONY (MA, LMFT, CMHS)
Entity Type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:ANTHONY
Last Name:RICH
Suffix:
Gender:M
Credentials:MA, LMFT, CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 FAIRVIEW AVE E
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3051
Mailing Address - Country:US
Mailing Address - Phone:206-595-5094
Mailing Address - Fax:206-458-6029
Practice Address - Street 1:3123 FAIRVIEW AVE E
Practice Address - Street 2:SUITE C
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3051
Practice Address - Country:US
Practice Address - Phone:206-595-5094
Practice Address - Fax:206-458-6029
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60034619101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional