| Doctor Name: | THAD SHANE DICKSON |
| NPI Number: | 1386930733 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CPHIMS, PMP |
| License Number: | |
| Business Practice Address: | 16511 34th Street Kp N Lakebay, WA - 983499774 |
| Business Phone Number: | 2536517482 |
| Business Fax Number: | |
| Mailing Address: | 16511 34th Street Kp N, LAKEBAY |
| State: | WA |
| Postal Code: | 983499774 |
| Phone Number: | 2536517482 |
| Fax Number: | |
| NPI Enumeration Date: | 06/23/2011 |
| NPI Last Update Date: | 05/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |