Provider Demographics
NPI:1235372004
Name:CRAYTON, SHANNON BARELLO (LCSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:BARELLO
Last Name:CRAYTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 ST HELENS AVE STE 103B
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3736
Mailing Address - Country:US
Mailing Address - Phone:757-921-7704
Mailing Address - Fax:
Practice Address - Street 1:711 ST HELENS AVE STE 103B
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3736
Practice Address - Country:US
Practice Address - Phone:253-514-6763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040071021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical