MEDICARE: JACKSONVILLE CENTER FOR SEXUAL HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH12328	FL

General Provider Information

NPI Number	:	1417373838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSONVILLE CENTER FOR SEXUAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	1637 RACE TRACK RD
Second Line	:	SUITE 225
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-3239
Country	:	US
Telephone Number	:	904-383-7613
Fax Number	:

Provider Business Practice Location Address
First Line	:	1637 RACE TRACK RD
Second Line	:	SUITE 225
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-3239
Country	:	US
Telephone Number	:	904-383-7613
Fax Number	:

Authorized Official
Title or Position	:	LICENSED MENTAL HEALTH COUNSELOR
Name	:	NOELLE POMEROY
Credential	:	LMHC
Telephone Number	:	904-383-7613

Provider Enumeration Date	:	03/10/2014
Last Update Date	:	11/04/2014

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