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General NPI Number Information
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NPI Number | 1922371996
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Entity Type | Organization
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Legal Business Name | SHIRLEY SHEN PHD LLC
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 02/21/2012
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Provider Practice Location Address
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Address Line | 1701 E EVERGREEN BLVD
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City | VANCOUVER
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State | WA
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Zip | 98661-4289
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Country | US
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Telephone | 503-998-6238
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Fax | 360-326-1651
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Provider Business Mailing Address
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Address Line | 703 NW 151ST ST
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City | VANCOUVER
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State | WA
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Zip | 98685-1753
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Country | US
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Telephone | 503-998-6238
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Fax | 360-326-1651
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHIRLEY K SHEN
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Credential | PH.D
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Telephone | 503-998-6238
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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 | PY00002736
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License Number State | WA
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