MEDICARE: MR. JOEL GLENN PRATHER PSY.D, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH9104	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063633444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOEL GLENN PRATHER PSY.D, LMHC

Provider Business Mailing Address
First Line	:	12133 PANAMA CITY BEACH PKWY
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2609
Country	:	US
Telephone Number	:	850-249-9636
Fax Number	:	850-249-9635

Provider Business Practice Location Address
First Line	:	12133 PANAMA CITY BEACH PKWY
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2609
Country	:	US
Telephone Number	:	850-249-9636
Fax Number	:	850-249-9635

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	03/03/2025

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