Provider Demographics
NPI:1356710339
Name:SHOUMAKER, DOUGLAS B (LSP, NCSP)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:B
Last Name:SHOUMAKER
Suffix:
Gender:M
Credentials:LSP, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 SW 97TH AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1410
Mailing Address - Country:US
Mailing Address - Phone:850-207-7560
Mailing Address - Fax:786-400-2134
Practice Address - Street 1:7001 SW 97TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1410
Practice Address - Country:US
Practice Address - Phone:850-207-7560
Practice Address - Fax:786-400-2134
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-19
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1233103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist