Provider Demographics
NPI:1598233066
Name:LUMA, SHAVON (MENTAL HEALTH THERAP)
Entity Type:Individual
Prefix:
First Name:SHAVON
Middle Name:
Last Name:LUMA
Suffix:
Gender:F
Credentials:MENTAL HEALTH THERAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 AMELIA CIR APT 8
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-6517
Mailing Address - Country:US
Mailing Address - Phone:561-914-4697
Mailing Address - Fax:
Practice Address - Street 1:304 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-2565
Practice Address - Country:US
Practice Address - Phone:561-914-4697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2019-04-19
Deactivation Date:2019-04-05
Deactivation Code:
Reactivation Date:2019-04-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator