Shade, David A
Shade, David A is an individual health care provider with primary practice located at 1815 Pleasant Grove Rd , Jonesboro AR 72401-7870. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Shade, David A can be contacted via phone (870) 933-6886.Contact Information
Primary practice address
1815 Pleasant Grove Rd
Jonesboro AR 72401-7870
Phone: (870) 933-6886
Fax: (870) 933-9395
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | 83-13EI | Arkansas |
Profile Details
| NPI number | 1083761464 |
|---|---|
| LBN Legal business name | Shade, David A |
| Credentials | M.S., LPE-I |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 5th, 2007 |
| Last updated | Nov 2nd, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083761464 | NPPES |
| Arkansas | MEDICAID | 198883795 | |
| Arkansas | Other | 5A020 |
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