Healthcare Provider Details

I. General information

NPI: 1043243587
Provider Name (Legal Business Name): JUNE SILAS LATNEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4317
US

IV. Provider business mailing address

4160 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4317
US

V. Phone/Fax

Practice location:
  • Phone: 904-376-3800
  • Fax: 904-733-9598
Mailing address:
  • Phone: 904-376-3800
  • Fax: 904-733-9598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW0003988
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: