Provider Demographics
NPI:1144563933
Name:MCCORMICK, SHELLY K (LMHC)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:K
Last Name:MCCORMICK
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 1:3161 57TH AVENUE CIR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-5332
Mailing Address - Country:US
Mailing Address - Phone:941-799-1976
Mailing Address - Fax:
Practice Address - Street 1:6497 PARKLAND DR STE A
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-4097
Practice Address - Country:US
Practice Address - Phone:941-799-1976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11632101YM0800X
FLMH 11632101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health