Provider Demographics
NPI:1164826574
Name:SHANDA BERDAN COUNSELING SERVICES
Entity Type:Organization
Organization Name:SHANDA BERDAN COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANDA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BERDAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LLBSW
Authorized Official - Phone:989-701-5836
Mailing Address - Street 1:216 HEBESTREIT ST
Mailing Address - Street 2:PO BOX 325
Mailing Address - City:ROSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48654-2503
Mailing Address - Country:US
Mailing Address - Phone:989-701-5836
Mailing Address - Fax:989-685-8363
Practice Address - Street 1:337 E HOUGHTON AVE
Practice Address - Street 2:CLINIC A, RM 5
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1127
Practice Address - Country:US
Practice Address - Phone:989-701-5836
Practice Address - Fax:989-685-8363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013102251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health