Provider Demographics
NPI:1225429376
Name:STATON, BRITT TISDALE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:BRITT
Middle Name:TISDALE
Last Name:STATON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 BRADSHAW TER
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1210
Mailing Address - Country:US
Mailing Address - Phone:321-695-5496
Mailing Address - Fax:
Practice Address - Street 1:912 BRADSHAW TER
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1210
Practice Address - Country:US
Practice Address - Phone:321-695-5496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10927101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health