Provider Demographics
NPI:1104315589
Name:MUXLOW, SHARI LYNN
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:LYNN
Last Name:MUXLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 HURON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3869
Mailing Address - Country:US
Mailing Address - Phone:810-689-9899
Mailing Address - Fax:810-662-0255
Practice Address - Street 1:309 HURON AVE STE B
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3869
Practice Address - Country:US
Practice Address - Phone:810-689-9899
Practice Address - Fax:810-662-0255
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional