Her Table Collective Therapy & Wellness LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

HER TABLE COLLECTIVE THERAPY & WELLNESS LLC

Practice address

7314 Mary Jo Ave
Southport, FL 32409-4162

Phone

(850) 565-9028

NPI assigned

Feb 25, 2025

Organization subpart

No

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

Authorized official

Name

Holly ChanceyNPI 1669152211

Title

Owner

Phone

(850) 565-9028

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Holly Chancey

  • Mental Health Counselor
  • Vancouver, WA
  • NPI 1669152211
  NPD Authorized official

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

{
    "created_epoch": "1740441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740441600000",
    "number": "1689471013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7314 MARY JO AVE",
            "city": "SOUTHPORT",
            "state": "FL",
            "postal_code": "324094162",
            "telephone_number": "850-565-9028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7314 MARY JO AVE",
            "city": "SOUTHPORT",
            "state": "FL",
            "postal_code": "324094162",
            "telephone_number": "850-565-9028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HER TABLE COLLECTIVE THERAPY & WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-25",
        "last_updated": "2025-02-25",
        "certification_date": "2025-02-25",
        "status": "A",
        "authorized_official_last_name": "CHANCEY",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-565-9028"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Robert Buchenhorst, APRN
• Lisha Myranda Estes, LMT
• Gina Hodges, LPN
• Jean, Ezechiel
• Ezechiel Jean
• Desiree Nichole Lafayette
• William Franklin McKeithen Jr., PTA

• Mental Health Counselor in Southport, FL
• Providers in Southport, 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 Feb 25, 2025; 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.