Provider Demographics
NPI:1922371996
Name:SHIRLEY SHEN PHD LLC
Entity type:Organization
Organization Name:SHIRLEY SHEN PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-998-6238
Mailing Address - Street 1:703 NW 151ST ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-1753
Mailing Address - Country:US
Mailing Address - Phone:503-998-6238
Mailing Address - Fax:360-326-1651
Practice Address - Street 1:1701 E EVERGREEN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-4289
Practice Address - Country:US
Practice Address - Phone:503-998-6238
Practice Address - Fax:360-326-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002736103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty