Provider Demographics
NPI:1215229588
Name:VICKI L SHUMAKER PLC
Entity Type:Organization
Organization Name:VICKI L SHUMAKER PLC
Other - Org Name:MEADOW RUN HOLISTIC COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHUMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMSW, CAADC
Authorized Official - Phone:269-945-8806
Mailing Address - Street 1:450 MEADOW RUN DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-9053
Mailing Address - Country:US
Mailing Address - Phone:269-945-8806
Mailing Address - Fax:269-945-8831
Practice Address - Street 1:450 MEADOW RUN DR
Practice Address - Street 2:SUITE 400
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-9053
Practice Address - Country:US
Practice Address - Phone:269-945-8806
Practice Address - Fax:269-945-8831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010892261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty