Provider Demographics
NPI:1538726120
Name:SHIPMAN, ANTHONY BERL (MA)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:BERL
Last Name:SHIPMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4628 FOWLER AVE APT 56
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2718
Mailing Address - Country:US
Mailing Address - Phone:406-230-2633
Mailing Address - Fax:
Practice Address - Street 1:6320 EVERGREEN WAY STE 201
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-4560
Practice Address - Country:US
Practice Address - Phone:425-350-2434
Practice Address - Fax:425-512-8049
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60958734101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health