Basic Information
| Provider Information | |||||||||
| NPI: | 1497093348 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHUSTER | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10785 S SAGINAW ST STE A | ||||||||
| Address2: | |||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484397003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106950055 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10785 S SAGINAW ST STE A | ||||||||
| Address2: | |||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484397003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106950055 | ||||||||
| FaxNumber: | 8106956813 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2013 | ||||||||
| LastUpdateDate: | 04/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801093824 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.