Healthcare Provider Details

I. General information

NPI: 1023332400
Provider Name (Legal Business Name): NATHAN D. SHIMER MHR, LMHC, CAP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5356 10TH ST
MALONE FL
32445-3429
US

IV. Provider business mailing address

5356 10TH ST
MALONE FL
32445-3429
US

V. Phone/Fax

Practice location:
  • Phone: 850-569-5355
  • Fax: 850-569-5205
Mailing address:
  • Phone: 850-569-5355
  • Fax: 850-569-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4100
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 10085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: