Doctor Name: | AMANDA SHANEBERGER |
NPI Number: | 1154476398 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 6401010181 |
Business Practice Address: | 3865 S Mackinac Trl Sault Sainte Marie, MI - 497839286 |
Business Phone Number: | 9066353742 |
Business Fax Number: | 9066321163 |
Mailing Address: | 3865 S Mackinac Trl, SAULT SAINTE MARIE |
State: | MI |
Postal Code: | 497839286 |
Phone Number: | 9066353742 |
Fax Number: | 9066321163 |
NPI Enumeration Date: | 01/25/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 6401010181 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |