Healthcare Provider Details

I. General information

NPI: 1174406466
Provider Name (Legal Business Name): PHOEBE SAMANTHA PARHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2025
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7775 BAYMEADOWS WAY STE 200
JACKSONVILLE FL
32256-7531
US

IV. Provider business mailing address

4207 CONFEDERATE POINT RD APT 22
JACKSONVILLE FL
32210-5468
US

V. Phone/Fax

Practice location:
  • Phone: 904-831-3974
  • Fax:
Mailing address:
  • Phone: 904-339-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: