Provider Demographics
NPI:1952818882
Name:SHALTRY, SHAWN DAVID (LLPC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:DAVID
Last Name:SHALTRY
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-2058
Mailing Address - Country:US
Mailing Address - Phone:517-862-7506
Mailing Address - Fax:
Practice Address - Street 1:1110 OLD POST RD
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-2058
Practice Address - Country:US
Practice Address - Phone:517-862-7506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-31
Last Update Date:2017-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health