MEDICARE: SHYLA STUART LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LF60327726	WA

General Provider Information

NPI Number	:	1326489659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHYLA STUART LMFT

Provider Business Mailing Address
First Line	:	8910 MAIN ST E
Second Line	:	SUITE F
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-8988
Country	:	US
Telephone Number	:	253-987-6234
Fax Number	:

Provider Business Practice Location Address
First Line	:	8910 MAIN ST E
Second Line	:	SUITE F
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-8988
Country	:	US
Telephone Number	:	253-987-6234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2013
Last Update Date	:	07/03/2015

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