Provider Demographics
NPI:1336372093
Name:SHOLTIS, MARK J (LMHC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:SHOLTIS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 LUTTERLOH RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32305-1100
Mailing Address - Country:US
Mailing Address - Phone:850-421-2656
Mailing Address - Fax:
Practice Address - Street 1:1228 LUTTERLOH RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32305-1100
Practice Address - Country:US
Practice Address - Phone:850-421-2656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1698101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health