Provider Demographics
NPI:1285198887
Name:BARNETT, SHELLY MARIE (LMFTA)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:MARIE
Last Name:BARNETT
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 G ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-4723
Mailing Address - Country:US
Mailing Address - Phone:714-290-5272
Mailing Address - Fax:
Practice Address - Street 1:612 WOODLAND SQUARE LOOP SE STE 401
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1070
Practice Address - Country:US
Practice Address - Phone:360-763-5828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60825688101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor