Provider Demographics
NPI:1942738513
Name:MENTUS, SHELLY A (LMHC, MCAP)
Entity type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:A
Last Name:MENTUS
Suffix:
Gender:F
Credentials:LMHC, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10428 YELLOW SPICE CT
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3410
Mailing Address - Country:US
Mailing Address - Phone:718-662-6473
Mailing Address - Fax:
Practice Address - Street 1:10428 YELLOW SPICE CT
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3410
Practice Address - Country:US
Practice Address - Phone:813-830-8055
Practice Address - Fax:813-319-5447
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23899101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015558700Medicaid
FLMH23899OtherIRS