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General NPI Number Information
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NPI Number | 1306388376
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Entity Type | Individual
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Provider Name | JUSTIN LEE SHOOP B.A., M.S.
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Gender | Male
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Dates
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Enumeration Date | 11/08/2016
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 4441 E KINGS CANYON RD
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City | FRESNO
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State | CA
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Zip | 93702-3604
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Country | US
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Telephone | 559-600-5998
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Fax |
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Provider Business Mailing Address
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Address Line | 2437 SIERRA AVE
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City | CLOVIS
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State | CA
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Zip | 93611-8917
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Country | US
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Telephone | 559-916-4461
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT107048
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 129926
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT129926
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License Number State | CA
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