Provider Demographics
NPI:1588269666
Name:MOLDOWAN, SHAWYN K (MA,LLPC)
Entity type:Individual
Prefix:MS
First Name:SHAWYN
Middle Name:K
Last Name:MOLDOWAN
Suffix:
Gender:F
Credentials:MA,LLPC
Other - Prefix:MRS
Other - First Name:SHAWYN
Other - Middle Name:K
Other - Last Name:LEHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16886 KINGSBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-3714
Mailing Address - Country:US
Mailing Address - Phone:586-484-3315
Mailing Address - Fax:
Practice Address - Street 1:16886 KINGSBROOKE DR
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-3714
Practice Address - Country:US
Practice Address - Phone:586-484-3315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor