Healthcare Provider Details

I. General information

NPI: 1477711182
Provider Name (Legal Business Name): WILLIAM S SHAUMAN MA LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W SOUTH ST
KALAMAZOO MI
49007-4711
US

IV. Provider business mailing address

122 WEST SOUTH STREET
KALAMAZOO MI
49007
US

V. Phone/Fax

Practice location:
  • Phone: 269-349-4219
  • Fax: 269-349-5107
Mailing address:
  • Phone: 269-349-4219
  • Fax: 269-349-5107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number6301007747
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: