Provider Demographics
NPI:1265280689
Name:KRUSZEWSKI, SHELLEY (MA, LLC)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:KRUSZEWSKI
Suffix:
Gender:F
Credentials:MA, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45445 MOUND RD STE 111
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5178
Mailing Address - Country:US
Mailing Address - Phone:586-254-3633
Mailing Address - Fax:
Practice Address - Street 1:45445 MOUND RD STE 111
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-5178
Practice Address - Country:US
Practice Address - Phone:586-254-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023017101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health