Provider Demographics
NPI:1881229151
Name:SHANNON SUGARMAN PSYCHOTHERAPY
Entity Type:Organization
Organization Name:SHANNON SUGARMAN PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANON
Authorized Official - Middle Name:BREISACHER
Authorized Official - Last Name:SUGARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:248-444-6978
Mailing Address - Street 1:27655 MIDDLEBELT RD STE 140
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-5029
Mailing Address - Country:US
Mailing Address - Phone:248-444-6978
Mailing Address - Fax:
Practice Address - Street 1:27655 MIDDLEBELT RD STE 140
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-5029
Practice Address - Country:US
Practice Address - Phone:248-444-6978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-07
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty