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General NPI Number Information
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NPI Number | 1447559513
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Entity Type | Individual
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Provider Name | KELLI LYNN SHAHEEN MA TLLP
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Gender | Female
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 03/15/2011
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Provider Practice Location Address
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Address Line | 5701 BOW POINTE DR STE 380
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City | CLARKSTON
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State | MI
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Zip | 48346-5406
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Country | US
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Telephone | 248-241-6514
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Fax |
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Provider Business Mailing Address
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Address Line | 5701 BOW POINTE DR STE 380
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City | CLARKSTON
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State | MI
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Zip | 48346-5406
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Country | US
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Telephone | 248-241-6514
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301014570
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License Number State | MI
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