Provider Demographics
NPI:1487409850
Name:SABU, SHALINI (LPC,TLLP)
Entity type:Individual
Prefix:
First Name:SHALINI
Middle Name:
Last Name:SABU
Suffix:
Gender:F
Credentials:LPC,TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PARKLANE BLVD STE 122
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4206
Mailing Address - Country:US
Mailing Address - Phone:313-649-7382
Mailing Address - Fax:
Practice Address - Street 1:6 PARKLANE BLVD STE 122
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4206
Practice Address - Country:US
Practice Address - Phone:313-649-7382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401223930103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling