Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Blair Evonne Shane

Individual provider Mental Health Counselor · NPI 1104696566

Blair Evonne Shane is a Mental Health Counselor in Jacksonville, Florida. Practices as a sole proprietor. Licensed in Florida.

Licensed in
FL
In the registry since
2024

Practice location Address checks out

3725 Belfort Rd
Jacksonville, FL 32216-5813
Phone: (904) 296-1055
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence IMH26957 (FL)

Record details

NPI number1104696566
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJanuary 8, 2024
Last updated in NPPESFebruary 14, 2025
Certification dateFebruary 14, 2025

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