=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386266096
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CALLIE CLINCH LMHC, NCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2020
-----------------------------------------------------
Last Update Date | 01/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3801 PGA BLVD STE 656
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-2756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-444-9788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 N US HIGHWAY 1 STE D10 #1107
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33477-5135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-444-9788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH17949
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------