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General NPI Number Information
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NPI Number | 1942738513
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Entity Type | Individual
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Provider Name | SHELLY A MENTUS LMHC, MCAP
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Gender | Female
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Dates
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Enumeration Date | 05/26/2017
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 10428 YELLOW SPICE CT
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City | RIVERVIEW
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State | FL
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Zip | 33578-3410
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Country | US
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Telephone | 813-830-8055
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Fax | 813-319-5447
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Provider Business Mailing Address
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Address Line | 10428 YELLOW SPICE CT
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City | RIVERVIEW
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State | FL
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Zip | 33578-3410
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Country | US
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Telephone | 718-662-6473
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MH23899
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License Number State | FL
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