Healthcare Provider Details

I. General information

NPI: 1750567707
Provider Name (Legal Business Name): ANITA M. PEMBLETON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2008
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 JAZZ DR
PANAMA CITY FL
32405-4906
US

IV. Provider business mailing address

PO BOX 977
PANAMA CITY FL
32402-0977
US

V. Phone/Fax

Practice location:
  • Phone: 850-296-8350
  • Fax: 872-246-8210
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 8956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: