Healthcare Provider Details

I. General information

NPI: 1144546292
Provider Name (Legal Business Name): SHUREE WAGGONER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 REDMOND WAY STE 101
REDMOND WA
98052-3862
US

IV. Provider business mailing address

15600 REDMOND WAY STE 101
REDMOND WA
98052-3862
US

V. Phone/Fax

Practice location:
  • Phone: 206-465-2981
  • Fax:
Mailing address:
  • Phone: 206-465-2981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60129959
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: