Provider Demographics
NPI:1457851560
Name:FITCH, TREGON (EDD, LMHC)
Entity Type:Individual
Prefix:
First Name:TREGON
Middle Name:
Last Name:FITCH
Suffix:
Gender:M
Credentials:EDD, LMHC
Other - Prefix:
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:FITCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EDD LMHC
Mailing Address - Street 1:2522 PELICAN BAY DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-7046
Mailing Address - Country:US
Mailing Address - Phone:706-332-6449
Mailing Address - Fax:
Practice Address - Street 1:2522 PELICAN BAY DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-7046
Practice Address - Country:US
Practice Address - Phone:706-332-6449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11097101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health