Provider Demographics
NPI:1598003469
Name:OKUMURA, SHIMON (LPC)
Entity Type:Individual
Prefix:MR
First Name:SHIMON
Middle Name:
Last Name:OKUMURA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3912 ELECTRIC RD
Mailing Address - Street 2:BUILDING C
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4513
Mailing Address - Country:US
Mailing Address - Phone:540-776-0716
Mailing Address - Fax:540-776-0717
Practice Address - Street 1:3912 ELECTRIC RD
Practice Address - Street 2:BUILDING C
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4513
Practice Address - Country:US
Practice Address - Phone:540-776-0716
Practice Address - Fax:540-776-0717
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005302101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health