Provider Demographics
NPI:1386002707
Name:SHUM, CHUN NING PETER (LMFT, LPCC)
Entity Type:Individual
Prefix:
First Name:CHUN NING PETER
Middle Name:
Last Name:SHUM
Suffix:
Gender:M
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:SHUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT, LPCC
Mailing Address - Street 1:PO BOX 25262
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-5262
Mailing Address - Country:US
Mailing Address - Phone:650-416-8622
Mailing Address - Fax:
Practice Address - Street 1:21710 STEVENS CREEK BLVD STE 105
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-1179
Practice Address - Country:US
Practice Address - Phone:650-416-8622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9488101YP2500X
CA117965106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional