Provider Demographics
NPI:1881717536
Name:SHELDER, THOMAS JOE (LMFT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JOE
Last Name:SHELDER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4833 MOULTON RD
Mailing Address - Street 2:
Mailing Address - City:GRAWN
Mailing Address - State:MI
Mailing Address - Zip Code:49637-9737
Mailing Address - Country:US
Mailing Address - Phone:231-645-3735
Mailing Address - Fax:231-276-9152
Practice Address - Street 1:902 W FRONT ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2328
Practice Address - Country:US
Practice Address - Phone:231-645-3735
Practice Address - Fax:231-276-9152
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006257106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist