=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255546172
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHEABRA LYNN SIMPSON PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19718 SUSSEX ST
-----------------------------------------------------
City | SAINT CLAIR SHORES
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48081-1020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-944-6449
-----------------------------------------------------
Fax | 313-887-1694
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19718 SUSSEX ST
-----------------------------------------------------
City | SAINT CLAIR SHORES
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48081-1020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-944-6449
-----------------------------------------------------
Fax | 313-887-1694
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 6301007449
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------