Healthcare Provider Details

I. General information

NPI: 1952815029
Provider Name (Legal Business Name): SHAWN LEE PEVERLY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAWN LEE JOHNSON LMHC

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 CORTEZ AVE
DE LEON SPRINGS FL
32130-3340
US

IV. Provider business mailing address

375 CORTEZ AVE
DE LEON SPRINGS FL
32130-3340
US

V. Phone/Fax

Practice location:
  • Phone: 407-617-6236
  • Fax:
Mailing address:
  • Phone: 407-617-6236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH14774
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: