Healthcare Provider Details

I. General information

NPI: 1124357264
Provider Name (Legal Business Name): KATHRYN GRACE STRICKLAND M.S., LMHC, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12422 NW G T REVELL RD
BRISTOL FL
32321-3007
US

IV. Provider business mailing address

12422 NW G T REVELL RD
BRISTOL FL
32321-3007
US

V. Phone/Fax

Practice location:
  • Phone: 850-573-4786
  • Fax: 850-643-2061
Mailing address:
  • Phone: 850-573-4786
  • Fax: 850-643-2061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10164
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: