Provider Demographics
NPI:1902607534
Name:SHIN, NATHAN (LMHCA)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:SHIN
Suffix:
Gender:
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12818 NE 120TH ST APT P11
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-8514
Mailing Address - Country:US
Mailing Address - Phone:253-880-7943
Mailing Address - Fax:
Practice Address - Street 1:2830 228TH AVE SE STE D
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-9300
Practice Address - Country:US
Practice Address - Phone:425-677-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61587856101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health