Provider Demographics
NPI:1730357997
Name:MM SHOBER INC
Entity type:Organization
Organization Name:MM SHOBER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHOBER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:360-317-8752
Mailing Address - Street 1:945 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-8876
Mailing Address - Country:US
Mailing Address - Phone:360-317-8752
Mailing Address - Fax:
Practice Address - Street 1:555 MCDONALD ST
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-7963
Practice Address - Country:US
Practice Address - Phone:360-317-8752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002085251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health