Provider Demographics
NPI:1447912050
Name:VINING, SHAUN
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:VINING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-3432
Mailing Address - Country:US
Mailing Address - Phone:269-966-1460
Mailing Address - Fax:269-966-2844
Practice Address - Street 1:175 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-3432
Practice Address - Country:US
Practice Address - Phone:269-966-1460
Practice Address - Fax:269-966-2844
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MI68511154131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator