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General NPI Number Information
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NPI Number | 1144546987
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Entity Type | Individual
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Provider Name | SHANA M HUIZENGA BCBA, LMHC, LBA
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Gender | Female
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Dates
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Enumeration Date | 04/19/2010
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Last Update Date | 09/17/2021
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Provider Practice Location Address
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Address Line | 23404 75TH AVE SE
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City | WOODINVILLE
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State | WA
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Zip | 98072-9729
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Country | US
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Telephone | 206-892-8421
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Fax |
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Provider Business Mailing Address
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Address Line | 14241 NE WOODINVILLE DUVALL RD # 346
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City | WOODINVILLE
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State | WA
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Zip | 98072-8564
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Country | US
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Telephone | 206-892-8421
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC 60178892
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-08-3995
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 60496390
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License Number State | WA
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