Provider Demographics
NPI:1336645779
Name:SUSAN A. SHIRLEY
Entity Type:Organization
Organization Name:SUSAN A. SHIRLEY
Other - Org Name:SUSAN A. SHIRLEY COUNSELING & CONSULTING INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LMHC
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-356-5486
Mailing Address - Street 1:11778 SW BENNINTON CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PORT ST. LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987
Mailing Address - Country:US
Mailing Address - Phone:337-356-5486
Mailing Address - Fax:
Practice Address - Street 1:2440 SE FEDERAL HWY STE 103
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4531
Practice Address - Country:US
Practice Address - Phone:337-356-5486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8882101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL60071Z761Medicaid