Provider Demographics
NPI:1760723977
Name:SHOUP, TONI JILL (MASTERS OF SCIENCE I)
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:JILL
Last Name:SHOUP
Suffix:
Gender:F
Credentials:MASTERS OF SCIENCE I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7922 WAVERLY STREET
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32466
Mailing Address - Country:US
Mailing Address - Phone:850-784-9025
Mailing Address - Fax:
Practice Address - Street 1:2711 WEST 15TH ST
Practice Address - Street 2:FLORIDA THERAPY
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401
Practice Address - Country:US
Practice Address - Phone:850-769-6001
Practice Address - Fax:850-769-6003
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health