Individual ProviderShane PatrickCounselorBehavioral Health & Social Service ProvidersPractice Address13128 Totem Lake Blvd NE, Kirkland, WA 98034-2953(425) 202-7748(210) 995-1099PECOS EnrollmentBased on the most recent information from CMS, provider Shane Patrick does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1598443020Provider TypeIndividualFull NamePatrick, ShaneCredentialMA, D.MIN, TH.M, MSGenderMaleSole ProprietorYesEnumeration Date7/6/2023Last Updated7/6/2023Contact InformationPractice LocationPractice Address13128 Totem Lake Blvd NE, Kirkland, WA 98034-2953Phone(425) 202-7748FaxUnlisted FaxMailing LocationMailing Address20402 63rd Ave NE, Kenmore, WA 98028-8630Phone(210) 995-1099FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer