1932145844 NPI number — SHELBY DEBAUSE LMFT

Table of content: SHELBY DEBAUSE LMFT (NPI 1932145844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932145844 NPI number — SHELBY DEBAUSE LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEBAUSE
Provider First Name:
SHELBY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT
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:
1932145844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2202 EXECUTIVE DR
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23666-6604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-827-7707
Provider Business Mailing Address Fax Number:
757-838-2573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2202 EXECUTIVE DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23666-6604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-827-7707
Provider Business Practice Location Address Fax Number:
757-838-2573
Provider Enumeration Date:
06/20/2006

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:  717001078 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PK100082781 . This is a "AMERICAN PYCH SERVICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: O80718M . This is a "SENTARA HEALTH MANAGEMENT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 191690 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7050631 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 239462 . This is a "COMPSYCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 339586 . This is a "MANAGED HEALTH NET/TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 738916000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 339586 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".




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