Provider Demographics
NPI:1285692277
Name:SHIRREFF, NEIL ROBERT (LICENSED PSYCHOLOGIS)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:ROBERT
Last Name:SHIRREFF
Suffix:
Gender:M
Credentials:LICENSED PSYCHOLOGIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 6TH ST SE
Mailing Address - Street 2:
Mailing Address - City:PELICAN RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56572-4630
Mailing Address - Country:US
Mailing Address - Phone:218-863-4833
Mailing Address - Fax:
Practice Address - Street 1:401 6TH ST SE
Practice Address - Street 2:
Practice Address - City:PELICAN RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56572-4630
Practice Address - Country:US
Practice Address - Phone:218-863-4833
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1852103T00000X
MN2156104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND68901SHOtherBCBS
MN68901SHOtherBCBS
MN131738OtherUCARE
MN610623OtherUHS INC
MN6106023OtherMEDICA