Healthcare Provider Details

I. General information

NPI: 1023697745
Provider Name (Legal Business Name): DISCOVERY MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13453 N MAIN ST STE 104
JACKSONVILLE FL
32218-2773
US

IV. Provider business mailing address

13453 N MAIN ST STE 104
JACKSONVILLE FL
32218-2773
US

V. Phone/Fax

Practice location:
  • Phone: 904-773-4390
  • Fax: 941-621-7089
Mailing address:
  • Phone: 904-773-4390
  • Fax: 941-621-7089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. KELLY LANE STEVENS
Title or Position: OWNER
Credential: LMFT
Phone: 904-294-6277