Provider Demographics
NPI:1386266096
Name:CLINCH, CALLIE (LMHC, NCC)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:CLINCH
Suffix:
Gender:
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N US HIGHWAY 1 STE D10
Mailing Address - Street 2:#1107
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5135
Mailing Address - Country:US
Mailing Address - Phone:561-444-9788
Mailing Address - Fax:
Practice Address - Street 1:2655 N OCEAN DR # 309
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-4751
Practice Address - Country:US
Practice Address - Phone:561-444-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17949101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health