Doctor Name: | BRITTANI SHAW |
NPI Number: | 1003297821 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 6401013688 |
Business Practice Address: | 901 Eastern Ave Ne Grand Rapids, MI - 495031201 |
Business Phone Number: | 6168184803 |
Business Fax Number: | 6167105176 |
Mailing Address: | 901 Eastern Ave Ne, GRAND RAPIDS |
State: | MI |
Postal Code: | 495031201 |
Phone Number: | 6168184803 |
Fax Number: | 6167105176 |
NPI Enumeration Date: | 06/17/2015 |
NPI Last Update Date: | 06/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 6401013688 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |