Provider Demographics
NPI:1144474263
Name:POVICH-SHUMATE, TAMMY (MHS)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:POVICH-SHUMATE
Suffix:
Gender:F
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 SHOENFELT ST
Mailing Address - Street 2:
Mailing Address - City:EAST FREEDOM
Mailing Address - State:PA
Mailing Address - Zip Code:16637-8032
Mailing Address - Country:US
Mailing Address - Phone:814-799-3888
Mailing Address - Fax:814-624-2452
Practice Address - Street 1:203 E PITT ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-1361
Practice Address - Country:US
Practice Address - Phone:814-799-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor