Healthcare Provider Details

I. General information

NPI: 1558502617
Provider Name (Legal Business Name): SHANNON RENEE BIRKHOLD LLP, LPC, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 PORTAGE RD
PORTAGE MI
49002-1774
US

IV. Provider business mailing address

418 W KALAMAZOO AVE
KALAMAZOO MI
49007-3334
US

V. Phone/Fax

Practice location:
  • Phone: 269-718-3366
  • Fax:
Mailing address:
  • Phone: 269-373-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301013953
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401011403
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: