Provider Demographics
NPI:1114167590
Name:SHACKELFORD, KAREN D (MA, LLPC, NCC)
Entity Type:Individual
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First Name:KAREN
Middle Name:D
Last Name:SHACKELFORD
Suffix:
Gender:F
Credentials:MA, LLPC, NCC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2661 S LAPEER RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-2261
Mailing Address - Country:US
Mailing Address - Phone:248-391-2606
Mailing Address - Fax:248-391-8862
Practice Address - Street 1:2661 S LAPEER RD
Practice Address - Street 2:SUITE 206
Practice Address - City:ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-2261
Practice Address - Country:US
Practice Address - Phone:248-391-2606
Practice Address - Fax:248-391-8862
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6401010512101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional