Provider Demographics
NPI:1316253834
Name:BARTON, SHANTA LEANETTA (LMHC MH11860)
Entity type:Individual
Prefix:MS
First Name:SHANTA
Middle Name:LEANETTA
Last Name:BARTON
Suffix:
Gender:F
Credentials:LMHC MH11860
Other - Prefix:MS
Other - First Name:SHANTA
Other - Middle Name:LEANETTA
Other - Last Name:BARTON - STUBBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:214 S PARRAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-2253
Mailing Address - Country:US
Mailing Address - Phone:321-388-1627
Mailing Address - Fax:
Practice Address - Street 1:2113 RUBY RED BLVD STE D
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-6115
Practice Address - Country:US
Practice Address - Phone:321-388-1627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-21
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11860101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251S00000XOtherCOMMUNITY/BEHAVIORAL HEALTH
FL1316253834Medicaid