Provider Demographics
NPI:1528402591
Name:ROBBENNOLT, SHANTY (MA, LPC, CAADC, CCS)
Entity Type:Individual
Prefix:
First Name:SHANTY
Middle Name:
Last Name:ROBBENNOLT
Suffix:
Gender:F
Credentials:MA, LPC, CAADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 S CREYTS RD STE C
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8263
Mailing Address - Country:US
Mailing Address - Phone:517-221-9522
Mailing Address - Fax:
Practice Address - Street 1:526 S CREYTS RD STE C
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8263
Practice Address - Country:US
Practice Address - Phone:517-221-9522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-02650101YA0400X
MI6401012596101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional