1275756249 NPI number — MRS. BARBARA H SHUMARD LMSW

Table of content: MRS. BARBARA H SHUMARD LMSW (NPI 1275756249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275756249 NPI number — MRS. BARBARA H SHUMARD LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHUMARD
Provider First Name:
BARBARA
Provider Middle Name:
H
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275756249
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3661 TERRACE HILLS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49203-4891
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-425-0396
Provider Business Mailing Address Fax Number:
734-425-0396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3661 TERRACE HILLS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49203-4891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-425-0396
Provider Business Practice Location Address Fax Number:
734-425-0396
Provider Enumeration Date:
04/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  4101005924 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 6801014716 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0963228 . This is a "BCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0963228 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 126240 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".