Healthcare Provider Details

I. General information

NPI: 1104668482
Provider Name (Legal Business Name): BRITTANY CLAYTON HIMERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/10/2024
Certification Date: 06/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N SEMORAN BLVD STE E
ORLANDO FL
32807-3562
US

IV. Provider business mailing address

5600 CENTURY 21 BLVD APT 111
ORLANDO FL
32807-2263
US

V. Phone/Fax

Practice location:
  • Phone: 407-823-8421
  • Fax: 407-823-8195
Mailing address:
  • Phone: 813-389-5719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH25957
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: