Provider Demographics
NPI:1891946653
Name:SHAFE, SUE A (LPC, LLP, CAC-R)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:A
Last Name:SHAFE
Suffix:
Gender:F
Credentials:LPC, LLP, CAC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 W MANCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-3016
Mailing Address - Country:US
Mailing Address - Phone:800-969-6162
Mailing Address - Fax:269-660-3899
Practice Address - Street 1:36 W MANCHESTER ST
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-3016
Practice Address - Country:US
Practice Address - Phone:800-969-6162
Practice Address - Fax:269-660-3899
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI200344101YA0400X
MI6401000012101YP2500X
MI6301007823103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling