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General NPI Number Information
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NPI Number | 1750217121
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Entity Type | Individual
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Provider Name | MR. SHANE BAGUYO
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Gender | Male
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Dates
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Enumeration Date | 06/22/2026
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Last Update Date | 06/22/2026
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Provider Practice Location Address
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Address Line | 4501 RAINIER AVE S
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City | SEATTLE
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State | WA
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Zip | 98118-1656
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Country | US
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Telephone | 206-536-7011
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Fax | 206-970-5854
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Provider Business Mailing Address
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Address Line | 13022 3RD AVE S
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City | BURIEN
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State | WA
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Zip | 98168-2644
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Country | US
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Telephone | 206-536-7011
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Fax | 206-970-5854
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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 | MHCA.MC.61409816
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License Number State | WA
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