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General NPI Number Information
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NPI Number | 1912404781
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Entity Type | Individual
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Provider Name | SARA ELIZABETH WALTER SHIHDANIAN MS, LMHC
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Gender | Female
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Dates
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Enumeration Date | 04/09/2018
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 843 WASHINGTON AVE APT 202
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City | DETROIT LAKES
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State | MN
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Zip | 56501-3057
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Country | US
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Telephone | 612-963-3861
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 2ND AVE STE 1770
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City | SEATTLE
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State | WA
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Zip | 98104-1046
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Country | US
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Telephone | 458-215-1812
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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 | 60111072
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | R5175
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License Number State | OR
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