Provider Demographics
NPI:1124357264
Name:STRICKLAND, KATHRYN GRACE (MS, LMHC, MT-BC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GRACE
Last Name:STRICKLAND
Suffix:
Gender:F
Credentials:MS, LMHC, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12422 NW G T REVELL RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-3007
Mailing Address - Country:US
Mailing Address - Phone:850-573-4786
Mailing Address - Fax:850-643-2061
Practice Address - Street 1:12422 NW G T REVELL RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-3007
Practice Address - Country:US
Practice Address - Phone:850-573-4786
Practice Address - Fax:850-643-2061
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10164101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health