# EXPERIENTIAL HEALING PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538961164
- **Authorized official:** SHANNON BRUNSON LMHC (OWNER/CEO)
- **Authorized official phone:** (850) 978-2852

## Contact information

- **Practice address:** 188 LODGE RD, FREEPORT, FL 32439-2212
- **Practice address phone:** (850) 333-6283
- **Mailing address:** 188 LODGE RD, FREEPORT, FL 32439-2212
- **Mailing address phone:** (850) 333-6283
- **Mailing address fax:** (850) 353-0003

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 03/25/2025
- **Last updated:** 02/11/2026