Provider Demographics
NPI:1912317090
Name:SHUNKWILER, THAD MATTHEW (LMFT)
Entity Type:Individual
Prefix:
First Name:THAD
Middle Name:MATTHEW
Last Name:SHUNKWILER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MADISON AVE; SUITE 610
Mailing Address - Street 2:ADULT, CHILD & FAMILY SERVICES LLC
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001
Mailing Address - Country:US
Mailing Address - Phone:507-387-3777
Mailing Address - Fax:507-344-1726
Practice Address - Street 1:1400 MADISON AVE; SUITE 610
Practice Address - Street 2:ADULT, CHILD & FAMILY SERVICES, LLC
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-387-3777
Practice Address - Fax:507-344-1726
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00517101YP2500X
MN2259106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional