Provider Demographics
NPI:1174054050
Name:JUMA, SHAMIM (MA, BCBA)
Entity type:Individual
Prefix:
First Name:SHAMIM
Middle Name:
Last Name:JUMA
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:SHAMIM
Other - Middle Name:
Other - Last Name:MANJI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 BROADFIELD BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-5162
Mailing Address - Country:US
Mailing Address - Phone:281-713-0280
Mailing Address - Fax:855-262-3737
Practice Address - Street 1:16000 PARK TEN PL STE 601
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7301
Practice Address - Country:US
Practice Address - Phone:281-713-0280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-15-20886103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4305831Medicaid