Individual ProviderChasity Shanell FowlkesCounselorBehavioral Health & Social Service ProvidersPractice Address2814 S Us Highway 1, Suite D4, Fort Pierce, FL 34982-8120(863) 669-8910(772) 208-7834PECOS EnrollmentBased on the most recent information from CMS, provider Chasity Shanell Fowlkes does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1992050728Provider TypeIndividualFull NameFowlkes, Chasity ShanellCredentialLMHC, CAPGenderFemaleSole ProprietorYesEnumeration Date7/18/2012Last Updated6/8/2023Contact InformationPractice LocationPractice Address2814 S Us Highway 1, Suite D4, Fort Pierce, FL 34982-8120Phone(863) 669-8910FaxUnlisted FaxMailing LocationMailing Address11582 SW Village Pkwy # 1137, Port Saint Lucie, FL 34987-2392Phone(772) 208-7834Fax(772) 607-5295Provider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseMH12547FloridaCode101Y00000XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode101YA0400XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer