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General NPI Number Information
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NPI Number | 1508681206
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Entity Type | Individual
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Provider Name | MICHAEL SHUMWAY LAC
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Gender | Male
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 3920 S RURAL RD STE 112
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City | TEMPE
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State | AZ
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Zip | 85282-5500
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Country | US
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Telephone | 480-428-2944
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Fax |
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Provider Business Mailing Address
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Address Line | 1647 S 82ND PL
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City | MESA
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State | AZ
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Zip | 85209-5459
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Country | US
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Telephone | 602-832-1386
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LAC-23195
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License Number State | AZ
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