Provider Demographics
NPI:1558407445
Name:SHEEHAN, MICHAEL C (EDD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:SHEEHAN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 HAYNES ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043
Mailing Address - Country:US
Mailing Address - Phone:931-552-2883
Mailing Address - Fax:931-647-8586
Practice Address - Street 1:1821 HAYNES ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4548
Practice Address - Country:US
Practice Address - Phone:931-552-2883
Practice Address - Fax:931-647-8586
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1134103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist