Provider Demographics
NPI:1588394597
Name:BUICE, SHAWN LEROY JR (LMHC)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:LEROY
Last Name:BUICE
Suffix:JR
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 1:6352A OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-8022
Mailing Address - Country:US
Mailing Address - Phone:850-420-9935
Mailing Address - Fax:
Practice Address - Street 1:7253 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32583-3045
Practice Address - Country:US
Practice Address - Phone:850-420-9935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health