Individual
MR. R. TIMOTHY SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LLPC
Contact information
Practice address
1012 W CROSS ST, YPSILANTI, MI 48197-2103
(734) 649-9989
Mailing address
1012 W CROSS ST, YPSILANTI, MI 48197-2103
(734) 649-9989
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
6401010082
MI
101YM0800X
Mental Health Counselor
—
MI
101YP1600X
Pastoral Counselor
—
MI
Other
Enumeration date
10/25/2007
Last updated
10/25/2007
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