Provider Demographics
NPI:1912710856
Name:SHADEL, TABATHA MAUREEN (LSWAIC)
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:MAUREEN
Last Name:SHADEL
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 SE TRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-1877
Mailing Address - Country:US
Mailing Address - Phone:708-466-7477
Mailing Address - Fax:
Practice Address - Street 1:1207 SE TRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:COLLEGE PLACE
Practice Address - State:WA
Practice Address - Zip Code:99324-1877
Practice Address - Country:US
Practice Address - Phone:708-466-7477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61614852101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health