Provider Demographics
NPI:1710643531
Name:SHIVERS, TAMARA GHESQUIERE (LPC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:GHESQUIERE
Last Name:SHIVERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5031 POINTE DR
Mailing Address - Street 2:
Mailing Address - City:EAST CHINA
Mailing Address - State:MI
Mailing Address - Zip Code:48054-3511
Mailing Address - Country:US
Mailing Address - Phone:810-650-2732
Mailing Address - Fax:
Practice Address - Street 1:240 S PARKER ST
Practice Address - Street 2:
Practice Address - City:MARINE CITY
Practice Address - State:MI
Practice Address - Zip Code:48039-3592
Practice Address - Country:US
Practice Address - Phone:810-300-6899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401224359101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional