Crystal Gillette Copeland
Individual provider Active NPI Mental Health Counselor · Fort Walton Beach, FL
NPI 1619635273 · NPPES record last updated Aug 20, 2023
Key facts
- NPI
- 1619635273
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- MH22502 (FL)
- Practice address
- 2514 Georgetown LN
Fort Walton Beach, FL 32547-6818 - Phone
- (850) 461-8340
- NPI assigned
- Dec 1, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IMH20777 | FL | MD | Mental Health Counselor |
| MH22502 | FL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PPCC, Inc. | Mental Health | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | IMH20777 | FL | |
| Mental Health Counselor |
101YM0800X | MH22502 | FL | Yes |
Addresses
Primary practice location
2514 Georgetown LN
Fort Walton Beach, FL 32547-6818
Mailing address
2514 Georgetown LN
Fort Walton Beach, FL 32547-6818
Phone (850) 461-8340
Other providers in Fort Walton Beach, FL
- Michayla Cook
- Candace Sue Cooley
- Sally A. Cooper
- Yvonne Cooper
- Sydney Ilana Cope
- David I Copeland
- Kendall Gail Corman II
- Caitlyn Marie-Rose Corn
- Glenn Cottrill
- Rachel L Couch
All providers in Fort Walton Beach, FL · Mental Health Counselor in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.