Provider Demographics
NPI:1023332400
Name:SHIMER, NATHAN D (MHR, LMHC, CAP)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:D
Last Name:SHIMER
Suffix:
Gender:M
Credentials:MHR, LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5356 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:FL
Mailing Address - Zip Code:32445-3429
Mailing Address - Country:US
Mailing Address - Phone:850-569-5355
Mailing Address - Fax:850-569-5205
Practice Address - Street 1:5356 10TH ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:FL
Practice Address - Zip Code:32445-3429
Practice Address - Country:US
Practice Address - Phone:850-569-5355
Practice Address - Fax:850-569-5205
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4100101YA0400X
FLMH 10085101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)