Provider Demographics
NPI:1013699206
Name:SHANNON M HARBIN PHD LLC
Entity Type:Organization
Organization Name:SHANNON M HARBIN PHD LLC
Other - Org Name:MINDFUL DEVELOPMENT, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARBIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-335-0845
Mailing Address - Street 1:36216 FREEDOM RD STE 27
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3002
Mailing Address - Country:US
Mailing Address - Phone:734-335-0845
Mailing Address - Fax:
Practice Address - Street 1:36216 FREEDOM RD STE 27
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-3002
Practice Address - Country:US
Practice Address - Phone:734-335-0845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health