1609090612 NPI number — MS. MARY ANN SHUMAN LPC LICENSED PROFESS

Table of content: MS. MARY ANN SHUMAN LPC LICENSED PROFESS (NPI 1609090612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609090612 NPI number — MS. MARY ANN SHUMAN LPC LICENSED PROFESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHUMAN
Provider First Name:
MARY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC LICENSED PROFESS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOEKSTRA
Provider Other First Name:
MARY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609090612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1693 SLATER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DORR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49323-9332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-681-2737
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2976 IVANREST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
GRANDVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49418-1440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-690-0500
Provider Business Practice Location Address Fax Number:
616-261-3047
Provider Enumeration Date:
04/12/2007

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: 101YP2500X , with the licence number:  6401005831 , 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: SHUMA0003 . This is a "COMPREHENSIVE BEHAVIORAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 563928 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".




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