Provider Demographics
NPI:1760937726
Name:DENNIS, SHAWN LONNIE (MASTER LEVEL THERAPY)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:LONNIE
Last Name:DENNIS
Suffix:
Gender:M
Credentials:MASTER LEVEL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4310 METRO PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-9416
Mailing Address - Country:US
Mailing Address - Phone:239-236-8784
Mailing Address - Fax:239-790-2624
Practice Address - Street 1:1542 KINGSLEY AVE STE 136
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4547
Practice Address - Country:US
Practice Address - Phone:904-458-7780
Practice Address - Fax:904-458-7781
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program