Healthcare Provider Details

I. General information

NPI: 1538982236
Provider Name (Legal Business Name): SHATARRA DEVOSE MA, LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2024
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 PACIFIC AVE STE 303
TACOMA WA
98402-4434
US

IV. Provider business mailing address

PO BOX 104
KENT WA
98035-0104
US

V. Phone/Fax

Practice location:
  • Phone: 425-386-5817
  • Fax: 425-242-4378
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61592868
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: