Active NPI
Sharay A Nickles, LMHC
- Mental Health Counselor
- Vaughn, WA
National Provider Identifier
1598840639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LH00010044
- Practice address
- 18404 97TH Street Court KP N
Vaughn, WA 98394-9735 - Phone
- (253) 324-8521
- Fax
- (253) 649-0025
- NPI assigned
- Oct 26, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LH00010044 | WA | Primary |
Addresses
Primary practice location
18404 97TH Street Court KP N
Vaughn, WA 98394-9735
Mailing address
PO Box 3421
Federal Way, WA 98063-3421
Phone (253) 324-8521
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093730 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LH00010044 | WA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492041600000",
"number": "1598840639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3421",
"city": "FEDERAL WAY",
"state": "WA",
"postal_code": "980633421",
"telephone_number": "253-324-8521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18404 97TH STREET COURT KP N",
"city": "VAUGHN",
"state": "WA",
"postal_code": "983949735",
"telephone_number": "253-324-8521",
"fax_number": "253-649-0025"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKLES",
"first_name": "SHARAY",
"middle_name": "A",
"credential": "LMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-26",
"last_updated": "2017-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "LH00010044",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1093730",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vaughn, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.