Provider Demographics
NPI:1316539893
Name:SHIRLY, DAVID (LMHC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SHIRLY
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 RIVER REACH DR APT 48
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-5277
Mailing Address - Country:US
Mailing Address - Phone:239-595-0076
Mailing Address - Fax:
Practice Address - Street 1:2500 AIRPORT RD S
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-4880
Practice Address - Country:US
Practice Address - Phone:239-309-1892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-06
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18828101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health