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Individual

DR. JOHN RICHARD SHACK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
713 WILDERNESS DR., DOUGLAS, MI 49406-0140
(269) 857-8644
(269) 857-8644
Mailing address
713 WILDERNESS DRIVE, P. O. BOX 140, DOUGLAS, MI 49406-0140
(269) 857-8644
(269) 857-8644

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301011374
MI

Other

Enumeration date
02/14/2008
Last updated
02/14/2008
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