Healthcare Provider Details

I. General information

NPI: 1558702316
Provider Name (Legal Business Name): BRYCE ALIKZANDR SHOEMAKER MA, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 02/25/2024
Certification Date: 02/25/2024
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 NumberLH 60582917
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: