1881823078 NPI number — MS. MICHELLE LEIGH SHAMBO LPCC, LMHC

Table of content: MS. MICHELLE LEIGH SHAMBO LPCC, LMHC (NPI 1881823078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881823078 NPI number — MS. MICHELLE LEIGH SHAMBO LPCC, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAMBO
Provider First Name:
MICHELLE
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPCC, LMHC
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:
1881823078
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 OSAGE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BISHOP
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93514-7466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-873-8980
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 OSAGE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BISHOP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93514-7466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-266-0778
Provider Business Practice Location Address Fax Number:
360-748-4762
Provider Enumeration Date:
07/08/2009

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: 101YM0800X , with the licence number:  LH60017481 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: LPC 407 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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