Provider Demographics
NPI:1477729895
Name:JOEL G PRATHER PSY.D, P.A.
Entity Type:Organization
Organization Name:JOEL G PRATHER PSY.D, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRATHER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:850-249-9736
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768539400Medicaid