Healthcare Provider Details

I. General information

NPI: 1902377641
Provider Name (Legal Business Name): DAVID ALLEN BINGHAM JR. LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 CELEBRATION BLVD STE 405
CELEBRATION FL
34747-5165
US

IV. Provider business mailing address

1530 CELEBRATION BLVD STE 405
CELEBRATION FL
34747-5165
US

V. Phone/Fax

Practice location:
  • Phone: 833-769-3524
  • Fax: 321-233-9959
Mailing address:
  • Phone: 833-769-3524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH23984
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC11533
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0118746
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: