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General NPI Number Information
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NPI Number | 1295079416
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL FITNESS ASSOCIATES, LLC
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 21903 PANAMA CITY BEACH PKWY
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32413-3219
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Country | US
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Telephone | 850-588-7089
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Fax |
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Provider Business Mailing Address
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Address Line | 21903 PANAMA CITY BEACH PKWY
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32413-3219
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Country | US
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Telephone | 850-588-7089
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MRS. LETICIA FREELAND GROVE
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Credential | LMHC
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Telephone | 850-291-1344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH9752
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License Number State | FL
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