Provider Demographics
NPI:1720356587
Name:RUBIN, SHAWN Y (LLPC)
Entity Type:Individual
Prefix:MISS
First Name:SHAWN
Middle Name:Y
Last Name:RUBIN
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 TIPTREE PATH
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-1330
Mailing Address - Country:US
Mailing Address - Phone:810-458-7194
Mailing Address - Fax:
Practice Address - Street 1:91 GLENDALE ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3274
Practice Address - Country:US
Practice Address - Phone:313-263-0077
Practice Address - Fax:313-883-0422
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011429101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health