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Individual

TIMOTHY W MCSHANE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MA, LPC, CAACD, NCC

Contact information

Practice address
516 CHERRY ST SE, GRAND RAPIDS, MI 49503-4702
(616) 456-6135
(231) 347-9313
Mailing address
516 CHERRY ST SE, GRAND RAPIDS, MI 49503-4702
(616) 456-6135
(616) 771-9779

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
101YP2500X
Professional Counselor
6401010843
MI
1041C0700X
Clinical Social Worker

Other

Enumeration date
12/10/2009
Last updated
03/07/2013
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