Provider Demographics
NPI:1487611497
Name:WHITE, SHANNON L (MS, LMHC)
Entity type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 E MEAD AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98903-3720
Mailing Address - Country:US
Mailing Address - Phone:509-453-1344
Mailing Address - Fax:509-453-2209
Practice Address - Street 1:918 E MEAD AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98903-3720
Practice Address - Country:US
Practice Address - Phone:509-453-1344
Practice Address - Fax:509-453-2209
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005517101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health