Facts
- Status
- A
- Credential
- M.S., LMHC, MT-BC
- Type
- Individual
- Enumeration date
- 2009-12-21
- Last updated
- 2009-12-21
Specialties
Licenses
- License FL
- MH10164
Location
- Practice location
- 12422 NW G T REVELL RD
- City
- BRISTOL FL
- Postal code
- 323213007
- Phone
- 850-573-4786
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.