Healthcare Provider Details

I. General information

NPI: 1982132247
Provider Name (Legal Business Name): SHIMMEL COUNSELING AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 05/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E MAPLE RD STE 122
BIRMINGHAM MI
48009-6408
US

IV. Provider business mailing address

2329 HARVARD RD
BERKLEY MI
48072-1751
US

V. Phone/Fax

Practice location:
  • Phone: 248-821-2981
  • Fax:
Mailing address:
  • Phone: 248-821-2981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6401012954
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number6401012954
License Number StateMI

VIII. Authorized Official

Name: DOUGLAS SHIMMEL
Title or Position: OWNER/COUNSELOR
Credential: MA, LLPC
Phone: 248-821-2981