Provider Demographics
NPI:1366750432
Name:BRESE, SHAWNDA L (MA, LMFT)
Entity type:Individual
Prefix:MRS
First Name:SHAWNDA
Middle Name:L
Last Name:BRESE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MS
Other - First Name:SHAWNDA
Other - Middle Name:L
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10715 VALLEY AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-2546
Mailing Address - Country:US
Mailing Address - Phone:253-733-1975
Mailing Address - Fax:
Practice Address - Street 1:601 VALLEY AVE NE
Practice Address - Street 2:SUITE F
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-2530
Practice Address - Country:US
Practice Address - Phone:253-733-1975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60462717106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist