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General NPI Number Information
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NPI Number | 1831174705
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Entity Type | Organization
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Legal Business Name | EMERALD COAST COUNSELING CENTER PA
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 215 MOUNTAIN DRIVE SUITE 106
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City | DESTIN
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State | FL
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Zip | 32541-2346
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Country | US
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Telephone | 850-837-9100
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Fax | 850-837-3774
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Provider Business Mailing Address
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Address Line | 215 MOUNTAIN DRIVE SUITE 106
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City | DESTIN
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State | FL
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Zip | 32541-2346
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Country | US
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Telephone | 850-837-9100
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Fax | 850-837-3774
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | LYLE J SANDQUIST
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Credential | PHD LMFT
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Telephone | 850-837-9100
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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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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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