Provider Demographics
NPI:1861278038
Name:SHUMATE, PHILLIP ANDREW
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ANDREW
Last Name:SHUMATE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 BERGLIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2053
Mailing Address - Country:US
Mailing Address - Phone:731-444-3766
Mailing Address - Fax:
Practice Address - Street 1:59 BERGLIN ST
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2053
Practice Address - Country:US
Practice Address - Phone:731-444-3766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health