Provider Demographics
NPI:1760252779
Name:SHANNON-HUTCHISON, NAT (LCSW (IL)/LLMSW (MI))
Entity type:Individual
Prefix:
First Name:NAT
Middle Name:
Last Name:SHANNON-HUTCHISON
Suffix:
Gender:M
Credentials:LCSW (IL)/LLMSW (MI)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5557 28TH ST SE STE B215
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-2025
Mailing Address - Country:US
Mailing Address - Phone:616-259-0186
Mailing Address - Fax:
Practice Address - Street 1:1000 MONROE AVE NW
Practice Address - Street 2:RIVER CITY PSYCHOLOGICAL SERVICES
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1455
Practice Address - Country:US
Practice Address - Phone:616-259-7207
Practice Address - Fax:616-259-7261
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILL6851111134104100000X
IL149.0260071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker