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General NPI Number Information
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NPI Number | 1265670244
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Entity Type | Organization
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Legal Business Name | LELAND E. SHIELDS
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Dates
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Enumeration Date | 01/28/2009
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Last Update Date | 01/28/2009
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Provider Practice Location Address
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Address Line | 2800 E MADISON ST SUITE 206
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City | SEATTLE
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State | WA
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Zip | 98112-4871
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Country | US
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Telephone | 206-568-0062
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Fax | 206-325-0098
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Provider Business Mailing Address
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Address Line | 2800 E MADISON ST SUITE 206
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City | SEATTLE
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State | WA
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Zip | 98112-4871
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Country | US
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Telephone | 206-568-0062
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Fax | 206-325-0098
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Authorized Official
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Title or Position | OWNER
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Name | MR. LELAND SHIELDS
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Credential | MS, MA
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Telephone | 206-568-0062
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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 | LH00010200
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License Number State | WA
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