Provider Demographics
NPI:1750852687
Name:MOLING, SHAWN (MA)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:MOLING
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 SW MADISON AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4757
Mailing Address - Country:US
Mailing Address - Phone:206-397-6066
Mailing Address - Fax:
Practice Address - Street 1:257 SW MADISON AVE STE 206
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4757
Practice Address - Country:US
Practice Address - Phone:206-397-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC7030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health