Provider Demographics
NPI:1982796645
Name:SHAUGHNESSY, THOMAS JOHN (LMHC CAP)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JOHN
Last Name:SHAUGHNESSY
Suffix:
Gender:M
Credentials:LMHC CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7511 LITTLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-5531
Mailing Address - Country:US
Mailing Address - Phone:727-817-1360
Mailing Address - Fax:727-815-9898
Practice Address - Street 1:7511 LITTLE RD STE 101
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-5531
Practice Address - Country:US
Practice Address - Phone:727-817-1360
Practice Address - Fax:727-815-9898
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4602101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ002LOtherBCBSFL