Healthcare Provider Details

I. General information

NPI: 1821596891
Provider Name (Legal Business Name): SHAHADA MITCHELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 09/29/2026
Certification Date: 10/05/2021
Deactivation Date: 09/09/2021
Reactivation Date: 10/05/2021

III. Provider practice location address

550 N REO ST
TAMPA FL
33609-1061
US

IV. Provider business mailing address

550 N REO ST
TAMPA FL
33609-1061
US

V. Phone/Fax

Practice location:
  • Phone: 813-374-2070
  • Fax: 813-337-0937
Mailing address:
  • Phone: 813-374-2070
  • Fax: 813-337-0937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number83663
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: