Provider Demographics
NPI:1649582156
Name:WEST, SHAUN MICHAEL (DBH, LPC, CAADC, ACS)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:MICHAEL
Last Name:WEST
Suffix:
Gender:M
Credentials:DBH, LPC, CAADC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57009 M 62 E
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-9773
Mailing Address - Country:US
Mailing Address - Phone:586-945-5426
Mailing Address - Fax:
Practice Address - Street 1:58620 SINK ROAD
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-9766
Practice Address - Country:US
Practice Address - Phone:269-782-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-02647101YA0400X
MI6401011945101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)