Healthcare Provider Details

I. General information

NPI: 1003179417
Provider Name (Legal Business Name): WILLIAM F SHOBE JR. LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BILL SHOBE LMFT

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 W MADRONE ST
ROSEBURG OR
97470-3090
US

IV. Provider business mailing address

PO BOX 1121
ROSEBURG OR
97470-0254
US

V. Phone/Fax

Practice location:
  • Phone: 541-492-4550
  • Fax: 541-440-3554
Mailing address:
  • Phone: 541-672-2691
  • Fax: 541-440-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT0653
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: