Healthcare Provider Details

I. General information

NPI: 1538706007
Provider Name (Legal Business Name): JOANN MASSEY PSY D
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 E DE SOTO ST
PENSACOLA FL
32501-3337
US

IV. Provider business mailing address

1221 E DE SOTO ST
PENSACOLA FL
32501-3337
US

V. Phone/Fax

Practice location:
  • Phone: 850-439-2100
  • Fax: 850-439-2122
Mailing address:
  • Phone: 850-439-2100
  • Fax: 850-439-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JOANN MASSEY
Title or Position: OWNER
Credential: PSY D
Phone: 850-384-1801