Healthcare Provider Details

I. General information

NPI: 1053678813
Provider Name (Legal Business Name): EMOTION MASTERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 HIGHWAY 87
NAVARRE FL
32566-3215
US

IV. Provider business mailing address

PO BOX 5897
NAVARRE FL
32566-0897
US

V. Phone/Fax

Practice location:
  • Phone: 850-376-2682
  • Fax: 850-290-5756
Mailing address:
  • Phone: 850-376-2682
  • Fax: 850-290-5756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4141
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4865
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2650
License Number StateFL

VIII. Authorized Official

Name: ALLISON P. VALEZ
Title or Position: OWNER
Credential: LMHC, LMFT, CAP
Phone: 850-376-2682