Provider Demographics
NPI:1043423692
Name:SHUMATE, STEPHEN GREGORY (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GREGORY
Last Name:SHUMATE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1263 LA BRANT RD
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911-6030
Mailing Address - Country:US
Mailing Address - Phone:406-837-4660
Mailing Address - Fax:
Practice Address - Street 1:1263 LA BRANT RD
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911-6030
Practice Address - Country:US
Practice Address - Phone:406-837-4660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT68101YA0400X
MT78101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional