Healthcare Provider Details

I. General information

NPI: 1073210043
Provider Name (Legal Business Name): BRYCE SHOEMAKER MA LMHC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 RAINIER AVE S STE C
SEATTLE WA
98118-6305
US

IV. Provider business mailing address

212 BROADWAY E UNIT 20775
SEATTLE WA
98102-7080
US

V. Phone/Fax

Practice location:
  • Phone: 206-339-7327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRYCE SHOEMAKER
Title or Position: SOLE OWNER
Credential:
Phone: 206-356-9327