Healthcare Provider Details

I. General information

NPI: 1144951773
Provider Name (Legal Business Name): JAIME SHOOSTER LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 NW 64TH TER STE A
GAINESVILLE FL
32605-4261
US

IV. Provider business mailing address

1131 NW 64TH TER STE A
GAINESVILLE FL
32605-4261
US

V. Phone/Fax

Practice location:
  • Phone: 352-363-2025
  • Fax: 352-363-2026
Mailing address:
  • Phone: 352-363-2025
  • Fax: 352-363-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH28005
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: