Provider Demographics
NPI:1538355722
Name:SHELSTAD, JANET R (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:R
Last Name:SHELSTAD
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:R
Other - Last Name:STODDARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:10116 36TH AVENUE CT SW
Mailing Address - Street 2:109
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4791
Mailing Address - Country:US
Mailing Address - Phone:253-332-1030
Mailing Address - Fax:
Practice Address - Street 1:10116 36TH AVENUE CT SW
Practice Address - Street 2:109
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4791
Practice Address - Country:US
Practice Address - Phone:253-332-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60071452106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2011491Medicaid
WALF60071452WOtherWA DOH