Active NPI
Brooke L Harrison, LMHC
- Mental Health Counselor
- Fort Walton Beach, FL
National Provider Identifier
1033510078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 12824
- Practice address
- 203 Cloverdale Blvd
Fort Walton Beach, FL 32547-1405 - Phone
- (850) 712-3779
- NPI assigned
- Sep 9, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 12824 | FL | Primary |
Addresses
Primary practice location
203 Cloverdale Blvd
Fort Walton Beach, FL 32547-1405
Mailing address
PO Box 800
Shalimar, FL 32579-0800
Phone (850) 712-3779
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 27, 2024 through Sep 27, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410220800000",
"number": "1033510078",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 800",
"city": "SHALIMAR",
"state": "FL",
"postal_code": "325790800",
"telephone_number": "850-712-3779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "203 CLOVERDALE BLVD",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325471405",
"telephone_number": "850-712-3779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRISON",
"first_name": "BROOKE",
"middle_name": "L",
"credential": "LMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-09-09",
"last_updated": "2014-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "12824",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Walton Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.