Provider Demographics
NPI:1710248034
Name:CONZ, SHANNON (MA, LLP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:CONZ
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 COOLIDGE HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1693
Mailing Address - Country:US
Mailing Address - Phone:734-218-0891
Mailing Address - Fax:
Practice Address - Street 1:3250 COOLIDGE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1693
Practice Address - Country:US
Practice Address - Phone:734-218-0891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011525103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical