Provider Demographics
NPI:1962016956
Name:SHUMWAY, COLIN (BCBA)
Entity Type:Individual
Prefix:MR
First Name:COLIN
Middle Name:
Last Name:SHUMWAY
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W CHESTNUT ST APT 314
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4389
Mailing Address - Country:US
Mailing Address - Phone:360-410-9557
Mailing Address - Fax:
Practice Address - Street 1:455 W STUART RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-1204
Practice Address - Country:US
Practice Address - Phone:360-348-6414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-17-28997103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst