Provider Demographics
NPI:1407095235
Name:CHURRUCA, SHABANA MANDVIWALA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SHABANA
Middle Name:MANDVIWALA
Last Name:CHURRUCA
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 1:3848 FLATIRON LOOP
Mailing Address - Street 2:SUITE #101
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7825
Mailing Address - Country:US
Mailing Address - Phone:813-777-3872
Mailing Address - Fax:813-864-6731
Practice Address - Street 1:3848 FLATIRON LOOP
Practice Address - Street 2:SUITE #101
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7825
Practice Address - Country:US
Practice Address - Phone:813-777-3872
Practice Address - Fax:813-864-6731
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8262101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health