Provider Demographics
NPI:1386884658
Name:SANTIAGO-SHUPE, MAYUMI MAE LACAYA (MS, MFT)
Entity type:Individual
Prefix:MS
First Name:MAYUMI MAE
Middle Name:LACAYA
Last Name:SANTIAGO-SHUPE
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 21022
Mailing Address - Street 2:MAPLE RIDGE SQUARE RPO
Mailing Address - City:MAPLE RIDGE
Mailing Address - State:BRITISH COLUMBIA
Mailing Address - Zip Code:V2X 1P7
Mailing Address - Country:CA
Mailing Address - Phone:778-386-2700
Mailing Address - Fax:
Practice Address - Street 1:RPO DEWDENY TRUNK ROAD
Practice Address - Street 2:MAPLE RIDGE SQUARE RPO
Practice Address - City:MAPLE RIDGE
Practice Address - State:BRITISH COLUMBIA
Practice Address - Zip Code:V2X 1P7
Practice Address - Country:CA
Practice Address - Phone:778-386-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 32554106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist