Individual provider Active NPI

Lisa Marie Shumake, RBT

  • Behavior Technician
  • Milton, FL
National Provider Identifier
1770123846
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
License
RBT-19-109408 Issued in FL
Practice address
4629 Church St
Milton, FL 32583-4107
Phone
(850) 503-6636
Fax
(850) 626-6132
NPI assigned
Jan 7, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X RBT-19-109408 FL Primary

Addresses

Primary practice location

4629 Church St
Milton, FL 32583-4107

Mailing address

4629 Church St
Milton, FL 32583-4107
Phone (505) 036-6368

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
RBT-19-109408FLMDBehavior Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Lifelong Behavioral Services, LLC CurrentSince Apr 13, 2025 Accepting new patients
Spectrum House Inc. PastSince Jul 24, 2022 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744156800000",
    "number": "1770123846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4629 CHURCH ST",
            "city": "MILTON",
            "state": "FL",
            "postal_code": "325834107",
            "telephone_number": "505-036-6368",
            "fax_number": "850-626-6132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4629 CHURCH ST",
            "city": "MILTON",
            "state": "FL",
            "postal_code": "325834107",
            "telephone_number": "850-503-6636",
            "fax_number": "850-626-6132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUMAKE",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "credential": "RBT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-07",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "RBT-19-109408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.