Provider Demographics
NPI:1831617281
Name:THE ANXIETY TREATMENT CENTER OF WEST MICHIGAN, PLLC
Entity type:Organization
Organization Name:THE ANXIETY TREATMENT CENTER OF WEST MICHIGAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:NABORS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:269-359-1873
Mailing Address - Street 1:350 E MICHIGAN AVE
Mailing Address - Street 2:17
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3800
Mailing Address - Country:US
Mailing Address - Phone:269-270-6840
Mailing Address - Fax:269-312-8781
Practice Address - Street 1:350 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3800
Practice Address - Country:US
Practice Address - Phone:269-270-6840
Practice Address - Fax:269-312-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014495101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty