Healthcare Provider Details

I. General information

NPI: 1952025280
Provider Name (Legal Business Name): PUZZLED CATERPILLARS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 ANISA CT
JACKSONVILLE FL
32209-3058
US

IV. Provider business mailing address

5230 ANISA CT
JACKSONVILLE FL
32209-3058
US

V. Phone/Fax

Practice location:
  • Phone: 904-597-1517
  • Fax: 904-216-3122
Mailing address:
  • Phone: 904-597-1517
  • Fax: 904-216-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: FRANCES L MCMILLER
Title or Position: OWNER
Credential:
Phone: 904-597-1517