MEDICARE: MR. BRADLEY ROE SHUMATE M.S, M.A., LMHC, LPC

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	MHC.LH.00005889	WA
2	101YP2500X	Professional Counselor	C3790	OR

General Provider Information

NPI Number	:	1558607994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRADLEY ROE SHUMATE M.S, M.A., LMHC, LPC

Provider Business Mailing Address
First Line	:	3532 S WAPITI LN
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-1208
Country	:	US
Telephone Number	:	360-600-1070
Fax Number	:	509-919-4494

Provider Business Practice Location Address
First Line	:	3532 S WAPITI LN
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-1208
Country	:	US
Telephone Number	:	360-600-1070
Fax Number	:	509-919-4494

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

Provider Enumeration Date	:	12/12/2012
Last Update Date	:	04/20/2026

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