Provider Demographics
NPI:1558874297
Name:DAVID SHOOTS COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:DAVID SHOOTS COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOOTS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:386-747-2331
Mailing Address - Street 1:215 S PALMETTO AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4308
Mailing Address - Country:US
Mailing Address - Phone:386-747-2331
Mailing Address - Fax:386-947-7441
Practice Address - Street 1:215 S PALMETTO AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4308
Practice Address - Country:US
Practice Address - Phone:386-747-2331
Practice Address - Fax:386-947-7441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW6973261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health