Doctor Name: | MR. ELLIOT MARC SHAMIS |
NPI Number: | 1336312362 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.S.,L.M.H.C. |
License Number: | MH2546 |
Business Practice Address: | 75 Fox Ridge Ct Suite C Debary, FL - 327132701 |
Business Phone Number: | 3866686989 |
Business Fax Number: | 3866686989 |
Mailing Address: | 75 Fox Ridge Ct, Suite C DEBARY |
State: | FL |
Postal Code: | 327132701 |
Phone Number: | 3866686989 |
Fax Number: | 3866686989 |
NPI Enumeration Date: | 04/10/2008 |
NPI Last Update Date: | 04/10/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH2546 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |