Healthcare Provider Details

I. General information

NPI: 1770121774
Provider Name (Legal Business Name): JOHN ARTHUR SHOREY MA, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HOWARD ST
KALAMAZOO MI
49001-2748
US

IV. Provider business mailing address

9661 FIREFLY AVE
GALESBURG MI
49053-9700
US

V. Phone/Fax

Practice location:
  • Phone: 269-344-4458
  • Fax: 269-344-4459
Mailing address:
  • Phone: 269-903-0527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: