Provider Demographics
NPI:1073200291
Name:SOMAYEH SHUNK, LLC
Entity Type:Organization
Organization Name:SOMAYEH SHUNK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SOMAYEH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUNK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:520-400-4349
Mailing Address - Street 1:7400 N ORACLE RD STE 323
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6341
Mailing Address - Country:US
Mailing Address - Phone:520-400-4349
Mailing Address - Fax:
Practice Address - Street 1:7400 N ORACLE RD STE 323
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6341
Practice Address - Country:US
Practice Address - Phone:520-400-4349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1487063822Medicaid