Provider Demographics
NPI:1538711122
Name:CARNLEY, CHRISTOPHER HAROLD JR (MS, LMHC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:HAROLD
Last Name:CARNLEY
Suffix:JR
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 AMBERJACK DR UNIT 26
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-6226
Mailing Address - Country:US
Mailing Address - Phone:850-377-3416
Mailing Address - Fax:
Practice Address - Street 1:151 MARY ESTHER BLVD # 201
Practice Address - Street 2:
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1972
Practice Address - Country:US
Practice Address - Phone:850-862-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16524101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health