Provider Demographics
NPI:1588601314
Name:MCPHERSON, SHONDA (LLP)
Entity Type:Individual
Prefix:MR
First Name:SHONDA
Middle Name:
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5041
Mailing Address - Country:US
Mailing Address - Phone:231-726-3582
Mailing Address - Fax:231-722-6933
Practice Address - Street 1:125 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5041
Practice Address - Country:US
Practice Address - Phone:231-726-3582
Practice Address - Fax:231-722-6933
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010539103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist