Provider Demographics
NPI:1568665669
Name:SHOOPMAN, BEVERLY (MS/MA MAC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:SHOOPMAN
Suffix:
Gender:F
Credentials:MS/MA MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2073 OLYMPIC ST. (COMMUNITY HEALTH CENTERS OF LANE CO)
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3413
Mailing Address - Country:US
Mailing Address - Phone:541-682-3550
Mailing Address - Fax:682-541-3551
Practice Address - Street 1:1200 HILYARD ST STE 450
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8164
Practice Address - Country:US
Practice Address - Phone:458-205-7131
Practice Address - Fax:458-205-7061
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR39632101Y00000X
OR12-06-102U3101YA0400X
101YM0800X
CA3921101YM0800X
ORC4158101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health