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General NPI Number Information
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NPI Number | 1518055565
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Entity Type | Individual
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Provider Name | MICHAEL ROBERT SHEEHAN PHD, HSPP
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1230 HILLCREST RD
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City | SOUTH BEND
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State | IN
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Zip | 46617-1169
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Country | US
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Telephone | 574-232-2600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1771
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City | SOUTH BEND
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State | IN
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Zip | 46634-1771
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Country | US
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Telephone | 574-232-2600
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Fax | 574-232-2627
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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 | 20010221A
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License Number State | IN
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