Basic Information
| Provider Information | |||||||||
| NPI: | 1386104610 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHANSHALA | ||||||||
| FirstName: | M. ELIZABETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4306 N FOXGLOVE DR NW | ||||||||
| Address2: | |||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983328028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538582494 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 33305 1ST WAY S STE B203 | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532355956 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2019 | ||||||||
| LastUpdateDate: | 03/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PY0002579 | WA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.