Provider Demographics
NPI:1962671735
Name:SHANK, STEVEN CARL (LMSW)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:CARL
Last Name:SHANK
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 N CONKLIN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-1712
Mailing Address - Country:US
Mailing Address - Phone:248-693-6375
Mailing Address - Fax:
Practice Address - Street 1:8062 ORTONVILLE RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4456
Practice Address - Country:US
Practice Address - Phone:248-625-2970
Practice Address - Fax:248-625-6829
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010064521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical