Basic Information
| Provider Information | |||||||||
| NPI: | 1558702316 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHOEMAKER | ||||||||
| FirstName: | BRYCE | ||||||||
| MiddleName: | ALIKZANDR | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15811 AMBAUM BLVD SW | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062428211 | ||||||||
| FaxNumber: | 2062420162 | ||||||||
| Practice Location | |||||||||
| Address1: | 15811 AMBAUM BLVD SW | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062428211 | ||||||||
| FaxNumber: | 2062420162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2013 | ||||||||
| LastUpdateDate: | 08/23/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LH 60582917 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.