Provider Demographics
NPI:1497029573
Name:SHADDINGER, BET (LMFT, BC-PTSD, CHT)
Entity Type:Individual
Prefix:MS
First Name:BET
Middle Name:
Last Name:SHADDINGER
Suffix:
Gender:F
Credentials:LMFT, BC-PTSD, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 MIDDLE RIVER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3559
Mailing Address - Country:US
Mailing Address - Phone:800-723-9788
Mailing Address - Fax:800-723-9788
Practice Address - Street 1:915 MIDDLE RIVER DR STE 201
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3559
Practice Address - Country:US
Practice Address - Phone:800-723-9788
Practice Address - Fax:800-723-9788
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2649106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017837600Medicaid