Shannon Dawn Coffey, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH4581 Issued in FL

Practice address

11820 Beach Blvd
Jacksonville, FL 32246-6670

Phone

(904) 642-9100

Fax

(904) 642-9108

NPI assigned

Mar 27, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shannon Dawn Ishee Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brandon Mental Health

  • Community/Behavioral Health Agency
  • Brandon, FL
  • NPI 1649421389
  Medicare reassignment NPD
• Ibis Healthcare Inc

  • Community/Behavioral Health Agency
  • Tampa, FL
  • NPI 1346224011
  Medicare reassignment NPD
• Ibis Healthcare Inc

  • Federally Qualified Health Center (FQHC)
  • Tampa, FL
  • NPI 1922777218
  NPD
• Mental Health Resource Center Inc

  • Community Health Clinic/Center
  • Jacksonville, FL
  • NPI 1851407365
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212451200000",
    "number": "1679745921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19249",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322459249",
            "telephone_number": "904-743-1883",
            "fax_number": "904-743-5109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11820 BEACH BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322466670",
            "telephone_number": "904-642-9100",
            "fax_number": "904-642-9108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COFFEY",
        "first_name": "SHANNON",
        "middle_name": "DAWN",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-27",
        "last_updated": "2008-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH4581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "762023300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "ISHEE",
            "middle_name": "DAWN",
            "credential": "LMHC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Murad Ishmael Cofer, PHARM.D
• Coffee & Grace LLC
• Angel Coffey, APRN
• Julie G. Coffey, LCSW, SW
• Olivetta Taffney Coffey
• Stephanie Marie Coffey, RN
• David Lee Coffman, MD
• Mariel Coffy
• Carlotta Cofield, BSN
• Kevin Michael Cofran, PA-C

• Mental Health Counselor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.