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General NPI Number Information
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NPI Number | 1598233066
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Entity Type | Individual
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Provider Name | SHAVON LUMA MENTAL HEALTH THERAP
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Gender | Female
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Dates
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Enumeration Date | 11/02/2018
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Last Update Date | 04/19/2019
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Provider Practice Location Address
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Address Line | 304 NW 5TH ST
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City | OKEECHOBEE
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State | FL
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Zip | 34972-2565
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Country | US
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Telephone | 561-914-4697
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Fax |
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Provider Business Mailing Address
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Address Line | 620 AMELIA CIR APT 8
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City | BELLE GLADE
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State | FL
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Zip | 33430-6517
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Country | US
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Telephone | 561-914-4697
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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