Healthcare Provider Details

I. General information

NPI: 1295973246
Provider Name (Legal Business Name): ANGELA SHOPMEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 E ROOSEVELT ST
PHOENIX AZ
85006-3641
US

IV. Provider business mailing address

1830 E ROOSEVELT ST
PHOENIX AZ
85006-3641
US

V. Phone/Fax

Practice location:
  • Phone: 602-256-5402
  • Fax: 602-256-5301
Mailing address:
  • Phone: 602-256-5402
  • Fax: 602-256-5301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13749
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: