Provider Demographics
NPI:1225585300
Name:WESS, NANCY LYNN I (LMHC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:WESS
Suffix:I
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 1:210 WATSON DR NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4238
Mailing Address - Country:US
Mailing Address - Phone:850-598-7704
Mailing Address - Fax:
Practice Address - Street 1:210 WATSON DR NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4238
Practice Address - Country:US
Practice Address - Phone:850-598-7704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 12584101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health