Provider Demographics
NPI:1891823225
Name:SHUMWAY, M RENA
Entity Type:Individual
Prefix:
First Name:M RENA
Middle Name:
Last Name:SHUMWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21030 MISSION ST STE A
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-6769
Mailing Address - Country:US
Mailing Address - Phone:661-822-8979
Mailing Address - Fax:661-822-5729
Practice Address - Street 1:21030 MISSION ST STE A
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-6769
Practice Address - Country:US
Practice Address - Phone:661-822-8979
Practice Address - Fax:661-822-5729
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)