Individual
SHANNON I AMBRUTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHRT-1
Contact information
Practice address
2 AIRPORT DR, PRESQUE ISLE, ME 04769-2041
(207) 764-0759
(207) 764-5631
Mailing address
2 AIRPORT DR, PRESQUE ISLE, ME 04769-2041
(207) 764-0759
(207) 764-5631
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103850000
—
ME
Enumeration date
01/11/2011
Last updated
01/11/2011
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