Provider Demographics
NPI:1174706048
Name:SHANTI COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:SHANTI COUNSELING SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CALLARD-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, ACSW, LMSW
Authorized Official - Phone:810-630-0904
Mailing Address - Street 1:6199 MILLER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-1585
Mailing Address - Country:US
Mailing Address - Phone:810-630-0904
Mailing Address - Fax:
Practice Address - Street 1:6199 MILLER RD
Practice Address - Street 2:SUITE A
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-1585
Practice Address - Country:US
Practice Address - Phone:810-630-0904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801067098261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1235158627OtherNPI
MI8008976950OtherBLUE CROSS BLUE SHIELD
MION94700Medicare PIN