MEDICARE: MRS. SHAWN LEE PEVERLY LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH14774	FL

General Provider Information

NPI Number	:	1952815029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAWN LEE PEVERLY LMHC

Provider Business Mailing Address
First Line	:	375 CORTEZ AVE
Second Line	:
City	:	DE LEON SPRINGS
State	:	FL
Zip	:	32130-3340
Country	:	US
Telephone Number	:	407-617-6236
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 CORTEZ AVE
Second Line	:
City	:	DE LEON SPRINGS
State	:	FL
Zip	:	32130-3340
Country	:	US
Telephone Number	:	407-617-6236
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2017
Last Update Date	:	04/05/2024

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