Provider Demographics
NPI:1518572783
Name:HOUSMAN, SHANNA ALINE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:ALINE
Last Name:HOUSMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 S 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-6706
Mailing Address - Country:US
Mailing Address - Phone:307-256-8410
Mailing Address - Fax:
Practice Address - Street 1:610 S 160TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-6706
Practice Address - Country:US
Practice Address - Phone:307-256-8410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017929101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health