Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Blue Tide Pediatric Therapy LLC

Organization Psychiatry Physician · NPI 1114654431

Blue Tide Pediatric Therapy LLC is a Psychiatry Physician in Destin, Florida. Registered with an NPI since 2022.

In the registry since
2022
Specialties on file
4
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4641 Gulfstarr Dr Ste 102
Destin, FL 32541-3776
Phone: (850) 964-6162
Fax: (850) 848-6643
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinic/Center (primary) Taxonomy 261Q00000X
Psychiatry Physician Taxonomy 2084P0800X
Massage Therapist Taxonomy 225700000X
Speech-Language Pathologist Taxonomy 235Z00000X

Record details

NPI number1114654431
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Garrett Outland — Owner/Speech-Language Pathologist · (850) 964-6162
Other names Blue Tide Therapy; Blue Tide Therapy
NPI enumeratedAugust 5, 2022
Last updated in NPPESJanuary 13, 2025
Certification dateJanuary 13, 2025
Mailing address4641 Gulfstarr Dr Ste 102, Destin, FL 32541-3776

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