Healthcare Provider Details

I. General information

NPI: 1881229151
Provider Name (Legal Business Name): SHANNON SUGARMAN PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2020
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27655 MIDDLEBELT RD STE 140
FARMINGTON HILLS MI
48334-5029
US

IV. Provider business mailing address

27655 MIDDLEBELT RD STE 140
FARMINGTON HILLS MI
48334-5029
US

V. Phone/Fax

Practice location:
  • Phone: 248-444-6978
  • Fax:
Mailing address:
  • Phone: 248-444-6978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SHANON BREISACHER SUGARMAN
Title or Position: PSYCOTHERAPIST
Credential: LLP
Phone: 248-444-6978