Provider Demographics
NPI:1932924115
Name:DIBAUM SHAFAR LLC
Entity type:Organization
Organization Name:DIBAUM SHAFAR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHAFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:509-952-2420
Mailing Address - Street 1:5015 TIETON DR STE 1
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3497
Mailing Address - Country:US
Mailing Address - Phone:509-952-2420
Mailing Address - Fax:
Practice Address - Street 1:5015 TIETON DR STE 1
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3497
Practice Address - Country:US
Practice Address - Phone:509-952-2420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIBAUM SHAFAR LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health