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2318 Cloudberry Dr Gulf Breeze FL 32563-9791 | |
| (757) 667-0615 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2318 Cloudberry Dr, Gulf Breeze, Florida |
| Authorized Official Name and Position | Reta Selitto (LICENSED PROFESSIONAL COUNSELOR) |
| Authorized Official Contact | 4348441206 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2318 Cloudberry Dr Gulf Breeze FL 32563-9791 Ph: (434) 844-1206 | 2318 Cloudberry Dr Gulf Breeze FL 32563-9791 Ph: (757) 667-0615 |
| NPI Number | 1013602242 |
|---|---|
| Provider Enumeration Date | 04/05/2023 |
| Last Update Date | 10/03/2024 |
| Certification Date | 10/03/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013602242 | NPI | - | NPPES |
| 1932870748 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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