Provider Demographics
NPI:1932829439
Name:RICKERT, SHANNON (LMHCA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:RICKERT
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 WAGNER WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-6904
Mailing Address - Country:US
Mailing Address - Phone:206-590-3755
Mailing Address - Fax:
Practice Address - Street 1:6626 WAGNER WAY STE 200
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-6904
Practice Address - Country:US
Practice Address - Phone:206-590-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60902592101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional