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NPI Code Detail

MEDICARE: BRIGHTER SHORES PSYCHOLOGY, LLC

MEDICARE: BRIGHTER SHORES PSYCHOLOGY, 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
1103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1851127443
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIGHTER SHORES PSYCHOLOGY, LLC
Provider Business Mailing Address
First Line : 476 RIVERSIDE AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32202-4912
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 476 RIVERSIDE AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32202-4912
Country : US
Telephone Number : 904-990-3379
Fax Number :
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : DR. HOLLAND HAYFORD
Credential : PHD
Telephone Number : 904-990-3379
Provider Enumeration Date : 09/10/2024
Last Update Date : 03/02/2026

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