Healthcare Provider Details

I. General information

NPI: 1376589051
Provider Name (Legal Business Name): MICHELLE MARIE SHOBER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MCDONALD
FRIDAY HARBOR WA
98250-8057
US

IV. Provider business mailing address

945 VICTORIA DR
FRIDAY HARBOR WA
98250-8876
US

V. Phone/Fax

Practice location:
  • Phone: 360-317-8752
  • Fax:
Mailing address:
  • Phone: 360-317-8752
  • Fax: 360-378-5458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY00002085
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: