Provider Demographics
NPI:1538835723
Name:SHEWMAKER, DIANE RUTH (LMHC, LPC, LCPC)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:RUTH
Last Name:SHEWMAKER
Suffix:
Gender:F
Credentials:LMHC, LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5319 BALUSTRADE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-5022
Mailing Address - Country:US
Mailing Address - Phone:360-412-5433
Mailing Address - Fax:360-412-5434
Practice Address - Street 1:5319 BALUSTRADE BLVD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98513-5022
Practice Address - Country:US
Practice Address - Phone:360-412-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0152101YM0800X
DCPRC89101YM0800X
WALH60149994101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health