Provider Demographics
NPI:1528621976
Name:LEE, SHAUNESE NICOLE (LMHC)
Entity type:Individual
Prefix:
First Name:SHAUNESE
Middle Name:NICOLE
Last Name:LEE
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 1:2641 ALEXANDER PL APT 302
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-1180
Mailing Address - Country:US
Mailing Address - Phone:813-523-0845
Mailing Address - Fax:
Practice Address - Street 1:2818 SATILLA LOOP
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-2736
Practice Address - Country:US
Practice Address - Phone:813-523-0845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-20
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health