Healthcare Provider Details

I. General information

NPI: 1770919086
Provider Name (Legal Business Name): ANDREW ISLES GALARNEAU MA, LMHC, CAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 PRUDENTIAL DR SUITE 510
JACKSONVILLE FL
32207-8210
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: 904-202-2436
Mailing address:
  • Phone: 904-376-3800
  • Fax: 904-202-2436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12041
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: