Healthcare Provider Details

I. General information

NPI: 1962917526
Provider Name (Legal Business Name): LENNI ERIN SHEA MA, SUDP, LMHCA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 19TH AVE E
SEATTLE WA
98112-4095
US

IV. Provider business mailing address

510 19TH AVE E
SEATTLE WA
98112-4095
US

V. Phone/Fax

Practice location:
  • Phone: 206-299-1303
  • Fax:
Mailing address:
  • Phone: 206-299-1303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60662707
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61308087
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCP60662707
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: