Provider Demographics
NPI:1932419678
Name:SYRKETT, GERALD MILTON (LMHC)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:MILTON
Last Name:SYRKETT
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 42ND WAY S
Mailing Address - Street 2:#L
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-4077
Mailing Address - Country:US
Mailing Address - Phone:727-433-2230
Mailing Address - Fax:
Practice Address - Street 1:3730 42ND WAY S
Practice Address - Street 2:#L
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-4077
Practice Address - Country:US
Practice Address - Phone:727-433-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMHC10464101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional