Provider Demographics
NPI:1649087149
Name:REKIEL, SHAWN PATRICK (M ED RMHCI)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:PATRICK
Last Name:REKIEL
Suffix:
Gender:M
Credentials:M ED RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7595 BAYMEADOWS CIR W APT 1008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-1849
Mailing Address - Country:US
Mailing Address - Phone:321-276-5656
Mailing Address - Fax:
Practice Address - Street 1:7595 BAYMEADOWS CIR W APT 1008
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1849
Practice Address - Country:US
Practice Address - Phone:321-276-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH21017101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health