Healthcare Provider Details

I. General information

NPI: 1356881841
Provider Name (Legal Business Name): WILLIAM SHANAHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9819 N INDIAN TRAIL RD
SPOKANE WA
99208-9359
US

IV. Provider business mailing address

9819 N INDIAN TRAIL RD
SPOKANE WA
99208-9359
US

V. Phone/Fax

Practice location:
  • Phone: 412-551-9803
  • Fax:
Mailing address:
  • Phone: 412-551-9803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-18189
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0013565
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC7208
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: