Individual
MICHAEL SHAMALOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
HSPP
Contact information
Practice address
500 8TH AVE, TERRE HAUTE, IN 47804-4072
(812) 231-8376
Mailing address
PO BOX 55107, INDIANAPOLIS, IN 46205-0107
(317) 253-7387
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
20043100A
IN
103TH0100X
Health Service Psychologist
Primary
—
—
Other
Enumeration date
01/24/2018
Last updated
02/07/2018
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