Healthcare Provider Details

I. General information

NPI: 1932924115
Provider Name (Legal Business Name): DIBAUM SHAFAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 07/27/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5015 TIETON DR STE 1
YAKIMA WA
98908-3497
US

IV. Provider business mailing address

5015 TIETON DR STE 1
YAKIMA WA
98908-3497
US

V. Phone/Fax

Practice location:
  • Phone: 509-952-2420
  • Fax:
Mailing address:
  • Phone: 509-952-2420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN J. SHAFAR
Title or Position: THERAPIST/OWNER
Credential: MA, LMHC
Phone: 509-952-2420