Provider Demographics
NPI:1194407783
Name:SHORES WELLNESS AND COUNSELING, PLLC
Entity type:Organization
Organization Name:SHORES WELLNESS AND COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRISHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:231-375-7873
Mailing Address - Street 1:794 PINE STREET
Mailing Address - Street 2:SUITE 230-O
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442
Mailing Address - Country:US
Mailing Address - Phone:231-375-7873
Mailing Address - Fax:231-788-9162
Practice Address - Street 1:794 PINE STREET
Practice Address - Street 2:SUITE 230-O
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442
Practice Address - Country:US
Practice Address - Phone:231-375-7873
Practice Address - Fax:231-788-9162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty