Provider Demographics
NPI:1881574523
Name:MINTER, SHANTAL
Entity type:Individual
Prefix:
First Name:SHANTAL
Middle Name:
Last Name:MINTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16817 ROBSON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-4048
Mailing Address - Country:US
Mailing Address - Phone:313-595-9433
Mailing Address - Fax:
Practice Address - Street 1:16817 ROBSON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-4048
Practice Address - Country:US
Practice Address - Phone:313-595-9433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor