Provider Demographics
NPI:1902669757
Name:CODY, ALICIA (LMHC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:CODY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9726 BLUE ISLE BAY
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2889
Mailing Address - Country:US
Mailing Address - Phone:954-854-1399
Mailing Address - Fax:
Practice Address - Street 1:9726 BLUE ISLE BAY
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-2889
Practice Address - Country:US
Practice Address - Phone:954-854-1399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23194101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health