Healthcare Provider Details

I. General information

NPI: 1942532403
Provider Name (Legal Business Name): HYDEE WARREN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HYDEE VANTERPOOL LMHC

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8833 PERIMETER PARK BLVD STE 201
JACKSONVILLE FL
32216
US

IV. Provider business mailing address

8833 PERIMETER PARK BLVD STE 201
JACKSONVILLE FL
32216-1111
US

V. Phone/Fax

Practice location:
  • Phone: 904-294-5329
  • Fax: 904-485-8460
Mailing address:
  • Phone: 904-294-5329
  • Fax: 904-485-8460

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 Code104100000X
TaxonomySocial Worker
License NumberMH11570
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMH11570
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMH11570
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberMH11570
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberMH11570
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH11570
License Number StateFL
# 11
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberMH11570
License Number StateFL
# 12
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: