Basic Information
| Provider Information | |||||||||
| NPI: | 1386807535 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLIGAN | ||||||||
| FirstName: | SHAWNA | ||||||||
| MiddleName: | MELISSA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MERRITT | ||||||||
| OtherFirstName: | SHAWNA | ||||||||
| OtherMiddleName: | MELISSA | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1685 BALDWIN AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | PONTIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483401115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487063450 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1685 BALDWIN AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | PONTIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483401115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487063450 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2008 | ||||||||
| LastUpdateDate: | 03/07/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | PENDING | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.