Samantha Collazo

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

907 Mar Walt Dr Ste 2021
Fort Walton Beach, FL 32547-6756

Phone

(850) 496-6923

NPI assigned

Aug 7, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674000000000",
    "number": "1609391069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4111",
            "city": "SHALIMAR",
            "state": "FL",
            "postal_code": "325794111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 MAR WALT DR STE 2021",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476756",
            "telephone_number": "850-496-6923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLAZO",
        "first_name": "SAMANTHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-07",
        "last_updated": "2023-01-18",
        "certification_date": "2023-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scarlett Codd, SLP
• Mikayla R Cody, RBT
• Van Scott Cogley, D.D.S.
• Tavares Cohens
• Harrison Anne Coles, LMT
• Faith Colley, CRNA
• Alicia Marie Colon, CST/ FA
• William Colon
• Compassionate Psychiatry PLLC
• Complete Rehabilitation Services, Inc.

• Mental Health Counselor in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.