Provider Demographics
NPI:1154070027
Name:SHAW-DRAVES PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:SHAW-DRAVES PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIMITED LICENSE PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:SHAW-DRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLP
Authorized Official - Phone:248-207-1499
Mailing Address - Street 1:2287 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-3302
Mailing Address - Country:US
Mailing Address - Phone:248-209-7149
Mailing Address - Fax:248-856-2783
Practice Address - Street 1:29501 GREENFIELD RD STE 138
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2250
Practice Address - Country:US
Practice Address - Phone:248-207-1499
Practice Address - Fax:248-856-2783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-19
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health