Healthcare Provider Details

I. General information

NPI: 1821785734
Provider Name (Legal Business Name): SHELLY MALIK CL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 SAND POINT WAY NE STE 100
SEATTLE WA
98105-3941
US

IV. Provider business mailing address

573 SADDLEBACK LOOP WAY NW
ISSAQUAH WA
98027-5646
US

V. Phone/Fax

Practice location:
  • Phone: 206-575-8880
  • Fax: 206-517-4491
Mailing address:
  • Phone: 425-465-5045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.61377719
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCL61423174
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: