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NPI Code Detail

MEDICARE: BEVERLY SHOOPMAN MS/MA MAC

MEDICARE: BEVERLY SHOOPMAN MS/MA MAC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor12-06-102U3OR
2101YM0800XMental Health Counselor3921CA
3101YM0800XMental Health Counselor
4101YP2500XProfessional CounselorC4158OR

General Provider Information

NPI Number : 1568665669
Entity Type Code : Individual
Provider Name (Legal Business Name) : BEVERLY SHOOPMAN MS/MA MAC
Provider Business Mailing Address
First Line : 140 S HOLLY ST
Second Line :
City : MEDFORD
State : OR
Zip : 97501-3113
Country : US
Telephone Number : 541-774-8200
Fax Number :
Provider Business Practice Location Address
First Line : 140 S HOLLY ST
Second Line :
City : MEDFORD
State : OR
Zip : 97501-3113
Country : US
Telephone Number : 541-774-8200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2007
Last Update Date : 01/02/2026

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Directions to “ BEVERLY SHOOPMAN MS/MA MAC” Practice Location

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