Provider Demographics
NPI:1144245564
Name:SMITH, SHIRLEY (LMHC)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14360 GREATER PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6557
Mailing Address - Country:US
Mailing Address - Phone:352-315-3913
Mailing Address - Fax:352-360-6582
Practice Address - Street 1:101 S 11TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5767
Practice Address - Country:US
Practice Address - Phone:352-315-3913
Practice Address - Fax:352-360-6582
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8709103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical