Provider Demographics
NPI:1538372347
Name:SHUMWAY, DAVID DEAN WILLIAM (MED)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:DEAN WILLIAM
Last Name:SHUMWAY
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 N. COUNTRY CLUB DRIVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201
Mailing Address - Country:US
Mailing Address - Phone:480-962-8883
Mailing Address - Fax:480-962-4308
Practice Address - Street 1:1150 N. COUNTRY CLUB DRIVE
Practice Address - Street 2:SUITE 10
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201
Practice Address - Country:US
Practice Address - Phone:480-962-8883
Practice Address - Fax:480-962-4308
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-0527101YA0400X
AZLPC-0265101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional