MEDICARE: HOPE HOUSE PSYCHOLOGICAL SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1487460135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE HOUSE PSYCHOLOGICAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	14101 PANAMA CITY BEACH PKWY STE 410
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32413-2871
Country	:	US
Telephone Number	:	850-312-8055
Fax Number	:

Provider Business Practice Location Address
First Line	:	14101 PANAMA CITY BEACH PKWY STE 410
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32413-2871
Country	:	US
Telephone Number	:	850-312-8055
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CRISTIE SEALEY
Credential	:	PH.D.
Telephone Number	:	850-312-8055

Provider Enumeration Date	:	12/07/2024
Last Update Date	:	01/27/2025

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