Provider Demographics
NPI:1992728588
Name:SHOEMAKER, DAVID SHOEMAKER A (LMFT)
Entity type:Individual
Prefix:
First Name:DAVID SHOEMAKER
Middle Name:A
Last Name:SHOEMAKER
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 1:615 N BERRY ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3016
Mailing Address - Country:US
Mailing Address - Phone:714-255-1873
Mailing Address - Fax:714-529-7715
Practice Address - Street 1:615 N BERRY ST
Practice Address - Street 2:SUITE J
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3016
Practice Address - Country:US
Practice Address - Phone:714-255-1873
Practice Address - Fax:714-529-7715
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22477101YA0400X, 101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health