1. Home
  2. Directory
  3. Michigan
  4. Douglas
  5. Psychologist
  6. NPI Profile

DR. JOHN RICHARD SHACK PH.D.
NPI 1942478706
Psychologist - Clinical in Douglas, MI

Active since February 14, 2008
713 WILDERNESS DR., DOUGLAS, MI 49406(269) 857-8644(269) 857-8644 Get Directions Write a Review

NPPES record last updated: February 14, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. John Richard Shack Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JOHN RICHARD SHACK PH.D. (NPI 1942478706) is an individual clinical provider in Douglas, Michigan, licensed in Michigan (6301011374) and active in the NPI registry since February 2008.

NPPES Registry Identity

NPI1942478706
Entity TypeIndividualMale
Primary Taxonomy103TC0700X
Provider Legal NameDR. JOHN RICHARD SHACKCredential: PH.D.
Location Address713 WILDERNESS DR.Douglas, MI 49406-0140
Mailing Address713 Wilderness Drive, P. O. Box 140Douglas, MI 49406-0140 · (269) 857-8644 · Fax (269) 857-8644
Phone(269) 857-8644
Fax(269) 857-8644
Sole ProprietorYes
Enumeration DateFebruary 14, 2008
✔ NPI 1942478706 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in MI · 6301011374
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
713 WILDERNESS DR., Douglas, MI 49406
Open in Google Maps ↗

Other Identifiers 1

Medicare PINOP23020MI

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is John Shack's NPI number?

The NPI number for John Shack is 1942478706. It was assigned to this individual provider in the NPPES registry on February 14, 2008.

Where is John Shack located?

John Shack practices at 713 Wilderness Dr., Douglas, MI 49406. The listed phone number is (269) 857-8644.

What is John Shack's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

When was this NPI record last updated?

The NPPES record for John Shack was last updated on February 14, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.