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NPI Code Detail

MEDICARE: MARY M SHOVELL RC

MEDICARE: MARY M SHOVELL RC
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
1101YM0800XMental Health CounselorRC00023446WA

General Provider Information

NPI Number : 1952470973
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY M SHOVELL RC
Provider Business Mailing Address
First Line : 1039 BASIN RD
Second Line :
City : COLVILLE
State : WA
Zip : 99114-8510
Country : US
Telephone Number : 509-684-5115
Fax Number :
Provider Business Practice Location Address
First Line : 165 E HAWTHORNE AVE
Second Line :
City : COLVILLE
State : WA
Zip : 99114-2629
Country : US
Telephone Number : 509-684-4597
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2006
Last Update Date : 07/08/2007

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