Provider Demographics
NPI:1003179417
Name:SHOBE, WILLIAM F JR (LMFT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:SHOBE
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:SHOBE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 1121
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-0254
Mailing Address - Country:US
Mailing Address - Phone:541-672-2691
Mailing Address - Fax:541-440-3554
Practice Address - Street 1:621 W MADRONE ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3090
Practice Address - Country:US
Practice Address - Phone:541-492-4550
Practice Address - Fax:541-440-3554
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0653106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500646731Medicaid