Provider Demographics
NPI:1144762691
Name:BLAKENEY, SHONTAY (LMHC)
Entity type:Individual
Prefix:
First Name:SHONTAY
Middle Name:
Last Name:BLAKENEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 WEST DR APT 819
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-5793
Mailing Address - Country:US
Mailing Address - Phone:843-510-4702
Mailing Address - Fax:
Practice Address - Street 1:8000 WEST DR APT 819
Practice Address - Street 2:
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-5793
Practice Address - Country:US
Practice Address - Phone:843-510-4702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23437101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health