Provider Demographics
NPI:1548921117
Name:NEUROBEHAVIORAL HEALTH AND WELLNESS
Entity type:Organization
Organization Name:NEUROBEHAVIORAL HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:517-899-2932
Mailing Address - Street 1:6420 QUAIL RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:DIMONDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48821-9680
Mailing Address - Country:US
Mailing Address - Phone:517-899-2932
Mailing Address - Fax:517-408-0134
Practice Address - Street 1:6420 QUAIL RIDGE LN
Practice Address - Street 2:
Practice Address - City:DIMONDALE
Practice Address - State:MI
Practice Address - Zip Code:48821-9680
Practice Address - Country:US
Practice Address - Phone:517-899-2932
Practice Address - Fax:517-408-0134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty