MEDICARE: KATHRYN MCDONALD SHUMATE LPC, LSATP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	071000875	VA
2	101YM0800X	Mental Health Counselor	0701000875	VA

General Provider Information

NPI Number	:	1013789882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN MCDONALD SHUMATE LPC, LSATP

Provider Business Mailing Address
First Line	:	1365 NE LAKEWOOD DR APT 322
Second Line	:
City	:	NEWPORT
State	:	OR
Zip	:	97365-1938
Country	:	US
Telephone Number	:	503-758-2093
Fax Number	:

Provider Business Practice Location Address
First Line	:	1365 NE LAKEWOOD DR APT 322
Second Line	:
City	:	NEWPORT
State	:	OR
Zip	:	97365-1938
Country	:	US
Telephone Number	:	503-758-2093
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2023
Last Update Date	:	10/25/2023

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