Provider Demographics
NPI:1720424245
Name:HOWARD, SHANNON B (LMFT, CAP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:B
Last Name:HOWARD
Suffix:
Gender:F
Credentials:LMFT, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2369 S OAK PARK DR
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-8412
Mailing Address - Country:US
Mailing Address - Phone:386-451-6343
Mailing Address - Fax:
Practice Address - Street 1:114 W NEW YORK AVE
Practice Address - Street 2:SUITE C
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-5416
Practice Address - Country:US
Practice Address - Phone:386-451-6343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2619106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008810600Medicaid