Healthcare Provider Details

I. General information

NPI: 1154070027
Provider Name (Legal Business Name): SHAW-DRAVES PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2022
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2287 FRANKLIN RD
BERKLEY MI
48072-3302
US

IV. Provider business mailing address

2287 FRANKLIN RD
BERKLEY MI
48072-3302
US

V. Phone/Fax

Practice location:
  • Phone: 248-207-1499
  • Fax:
Mailing address:
  • Phone: 248-209-7149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. ELIZABETH SUZANNE SHAW-DRAVES
Title or Position: LIMITED LICENSE PSYCHOLOGIST
Credential: M.A., LLP
Phone: 248-207-1499