MEDICARE: DAVID SHIRLY LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH18828	FL

General Provider Information

NPI Number	:	1316539893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID SHIRLY LMHC

Provider Business Mailing Address
First Line	:	2090 RIVER REACH DR APT 48
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34104-5277
Country	:	US
Telephone Number	:	239-595-0076
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 AIRPORT RD S
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34112-4880
Country	:	US
Telephone Number	:	239-309-1892
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2021
Last Update Date	:	02/06/2021

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