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General NPI Number Information
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NPI Number | 1760252779
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Entity Type | Individual
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Provider Name | NAT SHANNON-HUTCHISON LCSW (IL)/LLMSW (MI)
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Gender | Male
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Dates
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Enumeration Date | 01/02/2024
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 1000 MONROE AVE NW RIVER CITY PSYCHOLOGICAL SERVICES
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-1455
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Country | US
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Telephone | 616-259-7207
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Fax | 616-259-7261
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Provider Business Mailing Address
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Address Line | 5557 28TH ST SE STE B215
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City | GRAND RAPIDS
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State | MI
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Zip | 49512-2025
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Country | US
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Telephone | 616-259-0186
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LL6851111134
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.026007
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License Number State | IL
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