Provider Demographics
NPI:1407404262
Name:SHEHU, KRIS (TLLP)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:SHEHU
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 BROADWAY ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226
Mailing Address - Country:US
Mailing Address - Phone:313-312-5051
Mailing Address - Fax:
Practice Address - Street 1:1300 BROADWAY ST
Practice Address - Street 2:SUITE 400
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-4822
Practice Address - Country:US
Practice Address - Phone:313-312-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018060103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical