Provider Demographics
NPI:1760723563
Name:SHEAMAN INC.
Entity Type:Organization
Organization Name:SHEAMAN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE PYSCHOLOGIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-871-2165
Mailing Address - Street 1:1730 CLIFTON PL
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3242
Mailing Address - Country:US
Mailing Address - Phone:612-871-2165
Mailing Address - Fax:612-871-2448
Practice Address - Street 1:1730 CLIFTON PL
Practice Address - Street 2:SUITE 111
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3242
Practice Address - Country:US
Practice Address - Phone:612-871-2165
Practice Address - Fax:612-871-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2029261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN680000249Medicare PIN