Provider Demographics
NPI:1609090612
Name:SHUMAN, MARY ANN (LPC LICENSED PROFESS)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:SHUMAN
Suffix:
Gender:F
Credentials:LPC LICENSED PROFESS
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:HOEKSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1693 SLATER AVE
Mailing Address - Street 2:
Mailing Address - City:DORR
Mailing Address - State:MI
Mailing Address - Zip Code:49323-9332
Mailing Address - Country:US
Mailing Address - Phone:616-681-2737
Mailing Address - Fax:
Practice Address - Street 1:2976 IVANREST
Practice Address - Street 2:SUITE 205
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1440
Practice Address - Country:US
Practice Address - Phone:616-690-0500
Practice Address - Fax:616-261-3047
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005831101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SHUMA0003OtherCOMPREHENSIVE BEHAVIORAL
563928OtherVALUE OPTIONS