Provider Demographics
NPI:1144546987
Name:HUIZENGA, SHANA M (BCBA, LMHC, LBA)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:M
Last Name:HUIZENGA
Suffix:
Gender:F
Credentials:BCBA, LMHC, LBA
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:MARIE
Other - Last Name:ZITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA, LMHC, LBA
Mailing Address - Street 1:14241 NE WOODINVILLE DUVALL RD # 346
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8564
Mailing Address - Country:US
Mailing Address - Phone:206-892-8421
Mailing Address - Fax:
Practice Address - Street 1:23404 75TH AVE SE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-9729
Practice Address - Country:US
Practice Address - Phone:206-892-8421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60178892101YM0800X
CA1-08-3995103K00000X
WA60496390101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst