Healthcare Provider Details

I. General information

NPI: 1013459155
Provider Name (Legal Business Name): LEIGH SHINDELAR M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 09/18/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11382 WILSON ST
DEWITT MI
48820-9266
US

IV. Provider business mailing address

11382 WILSON ST
DEWITT MI
48820-9266
US

V. Phone/Fax

Practice location:
  • Phone: 541-870-1857
  • Fax:
Mailing address:
  • Phone: 541-870-1857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401015500
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401015500
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: