Doctor Name: | SHANNON RENEE BIRKHOLD |
NPI Number: | 1558502617 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | TLLP |
License Number: | 6301013953 |
Business Practice Address: | 960 E State St Cassopolis, MI - 490319339 |
Business Phone Number: | 2694452451 |
Business Fax Number: | 2694453216 |
Mailing Address: | 960 E State St, CASSOPOLIS |
State: | MI |
Postal Code: | 490319339 |
Phone Number: | 2694452451 |
Fax Number: | 2694453216 |
NPI Enumeration Date: | 03/18/2009 |
NPI Last Update Date: | 03/18/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC1900X |
License Number: | 6301013953 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Counseling |
Taxonomy Definition: |