Most Relevant Information
Provider Data
| NPI Number: | 1003297821 |
| Provider Name: | BRITTANI SHAW |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 6401013688 |
Most Important Dates
| Enumeration Date: | 06/17/2015 |
| Last Updated: | 06/17/2015 |
Provider Practice Location
901 EASTERN AVE NE
GRAND RAPIDS
MI
495031201
Practice Location Phone/Fax
| Phone: | 6168184803 |
| Fax: | 6167105176 |
Provider Mailing Location
901 EASTERN AVE NE
GRAND RAPIDS
MI
495031201
Provider Mailing Phone/Fax
| Phone: | 6168184803 |
| Fax: | 6167105176 |