Provider Demographics
NPI:1184052839
Name:SHANLIS COUNSELING & ASSESSMENT, INC
Entity type:Organization
Organization Name:SHANLIS COUNSELING & ASSESSMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:ATHENA
Authorized Official - Middle Name:PENELOPE
Authorized Official - Last Name:SCOTES
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:772-223-9988
Mailing Address - Street 1:430 SW CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2918
Mailing Address - Country:US
Mailing Address - Phone:772-223-9988
Mailing Address - Fax:772-223-9593
Practice Address - Street 1:430 SW CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2918
Practice Address - Country:US
Practice Address - Phone:772-223-9988
Practice Address - Fax:772-223-9593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty