Provider Demographics
NPI:1073345138
Name:SHOBA NISHEK LICSW, LLC
Entity type:Organization
Organization Name:SHOBA NISHEK LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHOBA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NISHEK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:509-570-6193
Mailing Address - Street 1:3001 S MOUNT VERNON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4755
Mailing Address - Country:US
Mailing Address - Phone:509-570-6193
Mailing Address - Fax:
Practice Address - Street 1:3001 S MOUNT VERNON ST STE 202
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4755
Practice Address - Country:US
Practice Address - Phone:509-570-6193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty