Healthcare Provider Details

I. General information

NPI: 1659037463
Provider Name (Legal Business Name): SHAYNA THOMPSON LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5126 W GRAND RIVER AVE STE B
LANSING MI
48906-9171
US

IV. Provider business mailing address

5126 W GRAND RIVER AVE STE B
LANSING MI
48906-9171
US

V. Phone/Fax

Practice location:
  • Phone: 517-580-2225
  • Fax:
Mailing address:
  • Phone: 517-580-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851118783
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: