Provider Demographics
NPI:1306289095
Name:MCCOTTRY, LA SHAUNE JALEEN
Entity type:Individual
Prefix:
First Name:LA SHAUNE
Middle Name:JALEEN
Last Name:MCCOTTRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12008 S SHORE BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6396
Mailing Address - Country:US
Mailing Address - Phone:561-223-1066
Mailing Address - Fax:
Practice Address - Street 1:12008 S SHORE BLVD STE 211
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6396
Practice Address - Country:US
Practice Address - Phone:561-223-1066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor