Healthcare Provider Details

I. General information

NPI: 1962671735
Provider Name (Legal Business Name): STEVEN CARL SHANK LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8062 ORTONVILLE RD
CLARKSTON MI
48348-4456
US

IV. Provider business mailing address

904 N CONKLIN RD
LAKE ORION MI
48362-1712
US

V. Phone/Fax

Practice location:
  • Phone: 248-625-2970
  • Fax: 248-625-6829
Mailing address:
  • Phone: 248-693-6375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801006452
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: