Healthcare Provider Details

I. General information

NPI: 1881717536
Provider Name (Legal Business Name): THOMAS JOE SHELDER LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 W FRONT ST
TRAVERSE CITY MI
49684-2328
US

IV. Provider business mailing address

4833 MOULTON RD
GRAWN MI
49637-9737
US

V. Phone/Fax

Practice location:
  • Phone: 231-645-3735
  • Fax: 231-276-9152
Mailing address:
  • Phone: 231-645-3735
  • Fax: 231-276-9152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101006257
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: