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General NPI Number Information
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NPI Number | 1508294901
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Entity Type | Organization
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Legal Business Name | SHANNON L GROH, MA, LPC COUNSELING, PLLC
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Dates
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Enumeration Date | 10/22/2013
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Last Update Date | 10/22/2013
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Provider Practice Location Address
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Address Line | 2600 MORTON AVE
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2141
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Country | US
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Telephone | 269-921-3643
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Fax |
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Provider Business Mailing Address
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Address Line | 3480 WYNDWICKE DR
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-8605
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | SHANNON L GROH
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Credential | LPC
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Telephone | 269-921-3643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6410103838
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License Number State | MI
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