Provider Demographics
NPI:1922035286
Name:SHOOTS, JOSEPH C (MA,TLLP,CAC-1)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:C
Last Name:SHOOTS
Suffix:
Gender:M
Credentials:MA,TLLP,CAC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 BEEMER CT
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-4802
Mailing Address - Country:US
Mailing Address - Phone:810-488-0490
Mailing Address - Fax:
Practice Address - Street 1:6548 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4823
Practice Address - Country:US
Practice Address - Phone:810-488-0490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013045103T00000X, 103TC1900X
MI6361005620103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling