Doctor Name: | MICHAEL R SHIRES |
NPI Number: | 1881628956 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.A. |
License Number: | PS005201L |
Business Practice Address: | 3212 Kutztown Rd Laureldale, PA - 196052661 |
Business Phone Number: | 6109291840 |
Business Fax Number: | 6109293810 |
Mailing Address: | 3212 Kutztown Rd, LAURELDALE |
State: | PA |
Postal Code: | 196052661 |
Phone Number: | 6109291840 |
Fax Number: | 6109293810 |
NPI Enumeration Date: | 07/11/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC1900X |
License Number: | PS005201L |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Counseling |
Taxonomy Definition: |