Provider Demographics
NPI:1962628404
Name:CRANSTON, SHANNON (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:CRANSTON
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1286 S LINDEN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3457
Mailing Address - Country:US
Mailing Address - Phone:810-407-7403
Mailing Address - Fax:888-478-2380
Practice Address - Street 1:1286 S LINDEN RD
Practice Address - Street 2:SUITE B
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3457
Practice Address - Country:US
Practice Address - Phone:810-407-7403
Practice Address - Fax:888-478-2380
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014638103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301014638OtherLICENSED PSYCHOLOGIST