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General NPI Number Information
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NPI Number | 1992071773
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Entity Type | Individual
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Provider Name | CHRISTY LYNN SHUTOK LMHC
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Gender | Female
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 10681 AIRPORT PULLING RD N STE 24
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City | NAPLES
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State | FL
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Zip | 34109-7332
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Country | US
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Telephone | 239-287-6624
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Fax |
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Provider Business Mailing Address
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Address Line | 2430 VANDERBILT BEACH RD STE 108
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City | NAPLES
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State | FL
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Zip | 34109-2654
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Country | US
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Telephone | 239-287-6244
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | MH10633
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License Number State | FL
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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 | MH10633
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License Number State | FL
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