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General NPI Number Information
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NPI Number | 1831711142
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Entity Type | Organization
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Legal Business Name | SHANNON S WYSINGER, LLC
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Dates
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Enumeration Date | 05/08/2020
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Last Update Date | 05/08/2020
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Provider Practice Location Address
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Address Line | 28475 GREENFIELD RD STE 113
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City | SOUTHFIELD
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State | MI
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Zip | 48076-3034
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Country | US
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Telephone | 810-510-0443
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Fax | 313-488-2736
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Provider Business Mailing Address
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Address Line | 1201 CEDAR BEND DR
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City | GRAND BLANC
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State | MI
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Zip | 48439-3405
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Country | US
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Telephone | 810-240-1849
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANNON WYSINGER
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Credential | LPC
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Telephone | 810-240-1849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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