Provider Demographics
NPI:1336312362
Name:SHAMIS, ELLIOT MARC (MS,LMHC)
Entity Type:Individual
Prefix:MR
First Name:ELLIOT
Middle Name:MARC
Last Name:SHAMIS
Suffix:
Gender:M
Credentials:MS,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FOX RIDGE CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2701
Mailing Address - Country:US
Mailing Address - Phone:386-668-6989
Mailing Address - Fax:386-668-6989
Practice Address - Street 1:75 FOX RIDGE CT
Practice Address - Street 2:SUITE C
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2701
Practice Address - Country:US
Practice Address - Phone:386-668-6989
Practice Address - Fax:386-668-6989
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2546101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health