=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700753639
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHILD AND ADOLESCENT PSYCHOLOGICAL AND COUNSELING SERVICES OF NW FLORIDA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2025
-----------------------------------------------------
Last Update Date | 10/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 336 FORT PICKENS RD APT E206
-----------------------------------------------------
City | PENSACOLA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32561-2048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-207-7671
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 336 FORT PICKENS RD APT E206
-----------------------------------------------------
City | PENSACOLA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32561-2048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-207-7671
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST/OWNER
-----------------------------------------------------
Name | MR. DOUGLAS BERRY SHOUMAKER
-----------------------------------------------------
Credential | PSYS. LSP, NCSP
-----------------------------------------------------
Telephone | 850-207-7671
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------