Unknown Individual – Clinical Psychologist, NPI 1417019050

Unknown Individual is a healthcare provider. based in Eglin afb, Florida. specializing in Clinical Psychologist. They hold a License No. PSY001368 (GA). The NPI Number for Unknown Individual is 1417019050

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1417019050
Phone
(850) 883-8600
Address
307 BOATNER RD STE 114
Deactivation Date
20 December 2023
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 307 BOATNER RD STE 114

    EGLIN AFB, FL 325421302

    Phone: (850) 883-8600

    Type: Mailing

  • Winn Army Community Hospital, 1061, Harmon Avenue, Bowen, Fort Stewart, Liberty County, Georgia, 31314, United States

    SUITE 1D03

    FORT STEWART, GA 313145641

    Phone: (912) 435-6965

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

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Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 32542)

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Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1417019050 if you need a stable reference for Unknown Individual.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Clinical Psychologist for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Eglin Afb, Florida because that is what the record indicates for Unknown Individual.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1417019050. Always confirm identity and privileges with the practice and licensing boards.

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