Provider Demographics
NPI:1952815029
Name:PEVERLY, SHAWN LEE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:LEE
Last Name:PEVERLY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:LEE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:375 CORTEZ AVE
Mailing Address - Street 2:
Mailing Address - City:DE LEON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32130-3340
Mailing Address - Country:US
Mailing Address - Phone:407-617-6236
Mailing Address - Fax:
Practice Address - Street 1:375 CORTEZ AVE
Practice Address - Street 2:
Practice Address - City:DE LEON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32130-3340
Practice Address - Country:US
Practice Address - Phone:407-617-6236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14774101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health