Provider Demographics
NPI:1659305308
Name:SHAMPO, WILLIAM H (LMSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:H
Last Name:SHAMPO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:427 S STEPHENSON AVE
Mailing Address - Street 2:STE 215
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3458
Mailing Address - Country:US
Mailing Address - Phone:906-774-3323
Mailing Address - Fax:906-774-2556
Practice Address - Street 1:427 S STEPHENSON AVE
Practice Address - Street 2:STE 215
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3458
Practice Address - Country:US
Practice Address - Phone:906-774-3323
Practice Address - Fax:906-774-2556
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801057938101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP34440005Medicare PIN