Provider Demographics
NPI:1629325345
Name:SHORIAK, TOMMY JAMES (MS, LMHC)
Entity Type:Individual
Prefix:MR
First Name:TOMMY
Middle Name:JAMES
Last Name:SHORIAK
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 S FISKE BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3045
Mailing Address - Country:US
Mailing Address - Phone:321-505-3330
Mailing Address - Fax:
Practice Address - Street 1:1824 S FISKE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3045
Practice Address - Country:US
Practice Address - Phone:321-505-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19138101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health