Healthcare Provider Details

I. General information

NPI: 1376137646
Provider Name (Legal Business Name): TLM COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 SUTTON PARK DR S
JACKSONVILLE FL
32224-5251
US

IV. Provider business mailing address

63 GALLEON DR
PONTE VEDRA FL
32081-0797
US

V. Phone/Fax

Practice location:
  • Phone: 904-460-7348
  • Fax: 904-431-3564
Mailing address:
  • Phone: 904-460-7348
  • Fax: 904-431-3564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. TARA LOUISE MCNAMARA
Title or Position: MENTAL HEALTH COUNSELOR/OWNER
Credential: LMHC
Phone: 904-460-7348