Provider Demographics
NPI:1932143781
Name:SEALEY, CRISTIE
Entity Type:Individual
Prefix:
First Name:CRISTIE
Middle Name:
Last Name:SEALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5753 HIGHWAY 85 N # 3308
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-9365
Mailing Address - Country:US
Mailing Address - Phone:417-399-1092
Mailing Address - Fax:
Practice Address - Street 1:140 N RICHARD JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2562
Practice Address - Country:US
Practice Address - Phone:417-399-1092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY12107103TC0700X
MO2006006564103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical