Provider Demographics
NPI:1508529900
Name:MIDDLETON, ERNEST EARL (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:EARL
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8665 SW CARRARA WAY
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-8704
Mailing Address - Country:US
Mailing Address - Phone:816-678-1124
Mailing Address - Fax:
Practice Address - Street 1:8665 SW CARRARA WAY
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-8704
Practice Address - Country:US
Practice Address - Phone:816-678-1124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional