Provider Demographics
NPI:1821147877
Name:HUGHES, SHELLY (LMHC)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:HUGHES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4375 US HIGHWAY 17 STE 103
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4832
Mailing Address - Country:US
Mailing Address - Phone:904-269-0886
Mailing Address - Fax:904-269-0449
Practice Address - Street 1:4375 US HIGHWAY 17 STE 103
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4832
Practice Address - Country:US
Practice Address - Phone:904-269-0886
Practice Address - Fax:904-269-0449
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4883101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ8968OtherBLUECROSS
FL763526500Medicaid