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General NPI Number Information
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NPI Number | 1336586338
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Entity Type | Organization
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Legal Business Name | CHRISTINE A. SHAMAN, LLC
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 3612 WHITE ROSE AVE
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City | BURNSVILLE
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State | MN
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Zip | 55337-2402
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Country | US
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Telephone | 651-492-0561
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Fax |
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Provider Business Mailing Address
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Address Line | 3612 WHITE ROSE AVE
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City | BURNSVILLE
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State | MN
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Zip | 55337-2402
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MSW, LICSW
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Name | CHIRSTINE SHAMAN
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Credential |
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Telephone | 651-492-0561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 15592
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License Number State | MN
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