1225092620 NPI number — MRS. SHANNON PONDER ADAMS LMHC RPTS

Table of content: MRS. SHANNON PONDER ADAMS LMHC RPTS (NPI 1225092620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225092620 NPI number — MRS. SHANNON PONDER ADAMS LMHC RPTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADAMS
Provider First Name:
SHANNON
Provider Middle Name:
PONDER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC RPTS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PONDER
Provider Other First Name:
SHANNON
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225092620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4220 SAXON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW SMYRNA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32169-3923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-973-7098
Provider Business Mailing Address Fax Number:
386-428-9675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 MAITLAND AVE
Provider Second Line Business Practice Location Address:
STE 307B
Provider Business Practice Location Address City Name:
ALTAMONTE SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32701-4910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-973-7098
Provider Business Practice Location Address Fax Number:
407-332-8069
Provider Enumeration Date:
04/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH6215 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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