# MICHAEL R SHANAHAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1962483313
- **Gender:** Man
- **Credential:** M.DIV/LMFT

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | 1279 | MN | — |
| 106H00000X | Marriage & Family Therapist | 1379 | MA | Yes |

## Other

- **Enumeration date:** 11/10/2005
- **Last updated:** 03/27/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 171987 | UCARE | MN |
| 05 | — | 407950700 | — | MN |
| 01 | — | 601120738 | MAGELLAN | MA |
| 01 | — | 70010000LF0190 | BCBS | MA |
| 01 | — | 820S5SH | BCBS | MN |