Doctor Name: | SHAWN MICHAEL PEPPLES |
NPI Number: | 1023442803 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CASAC-T |
License Number: | |
Business Practice Address: | 10 Mitchell Avenue Binghamton, NY - 13903 |
Business Phone Number: | 6077622109 |
Business Fax Number: | 6077622001 |
Mailing Address: | 346 Grand Ave, JOHNSON CITY |
State: | NY |
Postal Code: | 137902580 |
Phone Number: | 6077622109 |
Fax Number: | 6077622001 |
NPI Enumeration Date: | 08/28/2013 |
NPI Last Update Date: | 08/28/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |