Healthcare Provider Details

I. General information

NPI: 1013699206
Provider Name (Legal Business Name): SHANNON M HARBIN PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 10/04/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36216 FREEDOM RD STE 27
FARMINGTON HILLS MI
48335-3002
US

IV. Provider business mailing address

36216 FREEDOM RD STE 27
FARMINGTON HILLS MI
48335-3002
US

V. Phone/Fax

Practice location:
  • Phone: 734-335-0845
  • Fax:
Mailing address:
  • Phone: 734-335-0845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SHANNON M HARBIN
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 734-335-0845