Healthcare Provider Details

I. General information

NPI: 1235911256
Provider Name (Legal Business Name): AMBER LYNN GENTRY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 MAR WALT DR STE 2022
FORT WALTON BEACH FL
32547-6631
US

IV. Provider business mailing address

10 CHELSEA DR NW
FORT WALTON BEACH FL
32547-1606
US

V. Phone/Fax

Practice location:
  • Phone: 850-822-3013
  • Fax: 850-374-3192
Mailing address:
  • Phone: 850-496-1280
  • Fax: 850-374-3192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH26729
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: