Provider Demographics
NPI:1972943025
Name:DEXTER, GERALYN (MS, IMH, NCC)
Entity Type:Individual
Prefix:MISS
First Name:GERALYN
Middle Name:
Last Name:DEXTER
Suffix:
Gender:F
Credentials:MS, IMH, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7104 W CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2308
Mailing Address - Country:US
Mailing Address - Phone:813-610-8338
Mailing Address - Fax:
Practice Address - Street 1:12780 RACE TRACK RD
Practice Address - Street 2:SUITE 411
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1397
Practice Address - Country:US
Practice Address - Phone:813-610-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH10687101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health