Active NPI
Lauren Elizabeth Tilden
- Marriage & Family Therapist
- Fort Walton Beach, FL
National Provider Identifier
1699338921
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- IMT3322
- Practice address
- 907 Mar Walt Dr Ste 2021
Fort Walton Beach, FL 32547-6756 - Phone
- (850) 462-4386
- NPI assigned
- Apr 22, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 02475-I | NV | |
| Marriage & Family Therapist | 106H00000X | IMT3322 | FL | Primary |
Addresses
Primary practice location
907 Mar Walt Dr Ste 2021
Fort Walton Beach, FL 32547-6756
Mailing address
907 Mar Walt Dr Ste 2021
Fort Walton Beach, FL 32547-6756
Phone (850) 462-4386
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 23, 2024 through Sep 23, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02475-I | NV | MD | Addiction (Substance Use Disorder) Counselor |
| IMT3322 | FL | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659398400000",
"number": "1699338921",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "907 MAR WALT DR STE 2021",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325476756",
"telephone_number": "850-462-4386"
},
{
"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": "850-462-4386"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILDEN",
"first_name": "LAUREN",
"middle_name": "ELIZABETH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-04-22",
"last_updated": "2022-08-02",
"certification_date": "2022-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NV",
"license": "02475-I",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "FL",
"license": "IMT3322",
"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 Aug 2, 2022; 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.