Provider Demographics
NPI:1922156066
Name:SHULA, LORI MIONSKE (M A)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:MIONSKE
Last Name:SHULA
Suffix:
Gender:F
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 COLONIAL BLVD STE 253
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1028
Mailing Address - Country:US
Mailing Address - Phone:239-939-4566
Mailing Address - Fax:239-936-4413
Practice Address - Street 1:1400 COLONIAL BLVD STE 253
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1028
Practice Address - Country:US
Practice Address - Phone:239-939-4566
Practice Address - Fax:239-936-4413
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 3617101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health