Provider Demographics
NPI:1801923958
Name:SHUMARD, JESSICCA MAY (LPC)
Entity type:Individual
Prefix:
First Name:JESSICCA
Middle Name:MAY
Last Name:SHUMARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:MO
Mailing Address - Zip Code:64755-0128
Mailing Address - Country:US
Mailing Address - Phone:417-434-3177
Mailing Address - Fax:
Practice Address - Street 1:310 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:MO
Practice Address - Zip Code:64755
Practice Address - Country:US
Practice Address - Phone:417-434-3177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012007230101YP2500X, 101YP2500X
OK5205101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200512160AMedicaid