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General NPI Number Information
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NPI Number | 1427862960
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Entity Type | Organization
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Legal Business Name | BERRY WELLNESS GROUP
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Dates
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Enumeration Date | 02/05/2025
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 1701 TENNESSEE AVE
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City | LYNN HAVEN
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State | FL
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Zip | 32444-4208
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Country | US
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Telephone | 850-867-6777
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Fax | 850-248-2469
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Provider Business Mailing Address
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Address Line | 801 COLLEGE OAKS LN
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City | LYNN HAVEN
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State | FL
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Zip | 32444-9001
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Country | US
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Telephone | 850-630-4860
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Fax | 850-248-2469
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Authorized Official
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Title or Position | OWNER
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Name | KRISTINA NOBLE BERRY
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Credential | LMHC
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Telephone | 850-630-4860
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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 |
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License Number State |
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