Provider Demographics
NPI:1013073121
Name:EATON, SHEILA JOYCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:JOYCE
Last Name:EATON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31201 CHICAGO RD S
Mailing Address - Street 2:SUITE A102
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-5527
Mailing Address - Country:US
Mailing Address - Phone:586-795-4750
Mailing Address - Fax:586-795-4760
Practice Address - Street 1:31201 CHICAGO RD S
Practice Address - Street 2:SUITE A102
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-5527
Practice Address - Country:US
Practice Address - Phone:586-795-4750
Practice Address - Fax:586-795-4760
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006308103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E00067OtherBLUECROSSBLUE SHIELD
MI103641OtherVALUE OPTIONS
MI0E00067OtherBLUECROSSBLUE SHIELD