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General NPI Number Information
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NPI Number | 1568836088
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Entity Type | Individual
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Provider Name | MAX SHANNON PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 11/20/2015
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 6637 114TH AVE SE
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City | BELLEVUE
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State | WA
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Zip | 98006-6433
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Country | US
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Telephone | 503-766-3690
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Fax |
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Provider Business Mailing Address
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Address Line | 6637 114TH AVE SE
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City | BELLEVUE
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State | WA
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Zip | 98006-6433
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Country | US
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Telephone | 707-537-5754
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY61019392
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License Number State | WA
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