Provider Demographics
NPI:1184958134
Name:ROBERTS, SHANON KAYE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:SHANON
Middle Name:KAYE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 COMO ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3707
Mailing Address - Country:US
Mailing Address - Phone:813-254-3200
Mailing Address - Fax:
Practice Address - Street 1:205 COMO ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3707
Practice Address - Country:US
Practice Address - Phone:813-254-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8938101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor