Healthcare Provider Details

I. General information

NPI: 1902476948
Provider Name (Legal Business Name): SHELLY LYNN LARGENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SE WASHINGTON AVE. OPTIONAL
YAKIMA WA
98901
US

IV. Provider business mailing address

500 SE WASHINGTON AVE. OPTIONAL
YAKIMA WA
98901
US

V. Phone/Fax

Practice location:
  • Phone: 508-457-5653
  • Fax: 509-457-5653
Mailing address:
  • Phone: 508-457-5653
  • Fax: 509-457-5653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60298456
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: