Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. JOHN RICHARD SHACK, PH.D.
Active Sole ProprietorDR. JOHN RICHARD SHACK, PH.D. is a Clinical Psychologist healthcare provider located in DOUGLAS, Michigan. NPI 1942478706 is currently active in the NPPES registry. Verify at CMS.
Clinical Psychologist · DOUGLAS, MI
Registration Details
- NPI Number
- 1942478706
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Feb 14, 2008 (18.485189824084 yrs)
- Last Updated
- Feb 14, 2008
- License
-
6301011374 (MI)
- Sole Proprietor
- Yes
Practice Information
- Address
-
713 WILDERNESS DR.DOUGLAS, MI, 494060140Browse MI providers · Browse ZIP 49406
- Phone
- 2698578644
- Fax
- 2698578644
- Primary Specialty
-
Clinical Psychologist
103TC0700X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.