Provider Demographics
NPI:1699066688
Name:SHELLY ADAMSON COUNSELING LLC
Entity type:Organization
Organization Name:SHELLY ADAMSON COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ADAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC, NCC
Authorized Official - Phone:321-632-9929
Mailing Address - Street 1:3740 CURTIS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-3962
Mailing Address - Country:US
Mailing Address - Phone:321-632-9929
Mailing Address - Fax:321-631-6187
Practice Address - Street 1:3740 CURTIS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-3962
Practice Address - Country:US
Practice Address - Phone:321-632-9929
Practice Address - Fax:321-631-6187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5898101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty