Provider Demographics
NPI:1639134521
Name:SHINEDLING, TERESA CECELIA (LMSW ACSW MFT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:CECELIA
Last Name:SHINEDLING
Suffix:
Gender:F
Credentials:LMSW ACSW MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 653
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-0653
Mailing Address - Country:US
Mailing Address - Phone:435-652-3775
Mailing Address - Fax:435-652-8334
Practice Address - Street 1:2355 1/2 DELTA RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706
Practice Address - Country:US
Practice Address - Phone:989-667-5654
Practice Address - Fax:989-667-5330
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010079321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP208904820OtherBLUE CROSS
MI046048OtherVALUE OPTIONS
MIP208904820OtherBLUE CROSS