Provider Demographics
NPI:1063633444
Name:PRATHER, JOEL GLENN (PSYD, LMHC)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:GLENN
Last Name:PRATHER
Suffix:
Gender:M
Credentials:PSYD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12133 PANAMA CITY BEACH PKWY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2609
Mailing Address - Country:US
Mailing Address - Phone:850-249-9636
Mailing Address - Fax:850-249-9635
Practice Address - Street 1:12133 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2609
Practice Address - Country:US
Practice Address - Phone:850-249-9636
Practice Address - Fax:850-249-9635
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768539400Medicaid