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General NPI Number Information
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NPI Number | 1730117532
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Entity Type | Individual
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Provider Name | SHADSUN LEONARD RICE LMHC
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Gender | Male
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 709 S 5TH ST
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City | FORT PIERCE
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State | FL
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Zip | 34950-8339
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Country | US
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Telephone | 772-467-3040
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Fax |
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Provider Business Mailing Address
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Address Line | 155 NW WILLOW GROVE AVE
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-3564
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Country | US
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Telephone | 772-344-0402
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH5789
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License Number State | FL
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