Provider Demographics
NPI:1801208194
Name:FELICIA A GLEDHILL
Entity Type:Organization
Organization Name:FELICIA A GLEDHILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GLEDHILL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:850-301-0446
Mailing Address - Street 1:228 BROOKS ST SE
Mailing Address - Street 2:STE A
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-2800
Mailing Address - Country:US
Mailing Address - Phone:850-301-0446
Mailing Address - Fax:850-301-0442
Practice Address - Street 1:228 BROOKS ST SE
Practice Address - Street 2:STE A
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-2800
Practice Address - Country:US
Practice Address - Phone:850-301-0446
Practice Address - Fax:850-301-0442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3471251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH3471OtherFLORIDA BLUE