Individual
MR. TYRONE RICHARD SHUMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
732 WASHINGTON AVE, POCATELLO, ID 83201-3748
(208) 478-9822
Mailing address
1326 KIERSTEN DR, CHUBBUCK, ID 83202-7704
(208) 234-7032
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-30671
ID
Other
Enumeration date
01/11/2011
Last updated
01/11/2011
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