Healthcare Provider Details

I. General information

NPI: 1548182199
Provider Name (Legal Business Name): LAUREN A HEUSSER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10245 CENTURION PKWY N STE 250
JACKSONVILLE FL
32256-0561
US

IV. Provider business mailing address

2549 MYRA ST
JACKSONVILLE FL
32204-3515
US

V. Phone/Fax

Practice location:
  • Phone: 904-674-3521
  • Fax:
Mailing address:
  • Phone: 845-536-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27261
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: