Healthcare Provider Details

I. General information

NPI: 1285085563
Provider Name (Legal Business Name): MARY SHANNON SMITH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 S DIXIE HWY STE 880
MIAMI FL
33156-2839
US

IV. Provider business mailing address

7255 SW 108TH TER
PINECREST FL
33156-3851
US

V. Phone/Fax

Practice location:
  • Phone: 786-808-4673
  • Fax:
Mailing address:
  • Phone: 786-484-8148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH28029
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: