1538355722 NPI number — MS. JANET R SHELSTAD MA, LMFT

Table of content: MS. JANET R SHELSTAD MA, LMFT (NPI 1538355722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538355722 NPI number — MS. JANET R SHELSTAD MA, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHELSTAD
Provider First Name:
JANET
Provider Middle Name:
R
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STODDARD
Provider Other First Name:
JANET
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538355722
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10116 36TH AVENUE CT SW
Provider Second Line Business Mailing Address:
109
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98499-4791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-332-1030
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10116 36TH AVENUE CT SW
Provider Second Line Business Practice Location Address:
109
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-4791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-332-1030
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  LF60071452 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2011491 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LF60071452W . This is a "WA DOH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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