1316121460 NPI number — SHAWN E BEARWOOD LMHC, CDP

Table of content: SHAWN E BEARWOOD LMHC, CDP (NPI 1316121460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316121460 NPI number — SHAWN E BEARWOOD LMHC, CDP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEARWOOD
Provider First Name:
SHAWN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC, CDP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BEARWOOD
Provider Other First Name:
SHAMORA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1316121460
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P. O. BOX 73
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVANA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98287
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-333-8433
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16404 SMOKEY POINT BLVD STE 208
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98223-8417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-708-5040
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2007

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: 101YM0800X , with the licence number:  LH60227285 , 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: RC00041996 . This is a "REGISTERED COUNSELOR" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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