Leo Haywood Shealy, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH18043 Issued in FL

Practice address

309 Williams Ave
Port St Joe, FL 32456-1845

Phone

(850) 896-4385

NPI assigned

May 7, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1588809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588809600000",
    "number": "1962024406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "274 LITTLE CREEK RD",
            "city": "WEWAHITCHKA",
            "state": "FL",
            "postal_code": "324656463",
            "telephone_number": "850-896-4385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 WILLIAMS AVE",
            "city": "PORT ST JOE",
            "state": "FL",
            "postal_code": "324561845",
            "telephone_number": "850-896-4385"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "525 E 15th St",
            "address_purpose": "LOCATION",
            "city": "Panama City",
            "state": "FL",
            "postal_code": "324055412",
            "country_code": "US",
            "telephone_number": "850-522-4485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHEALY",
        "first_name": "LEO",
        "middle_name": "HAYWOOD",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-05-07",
        "last_updated": "2020-05-07",
        "certification_date": "2020-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH18043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Port St Joe, FL
• Providers in Port St Joe, 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 May 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.