Healthcare Provider Details

I. General information

NPI: 1184337305
Provider Name (Legal Business Name): MISSING PIECE BEHAVIORAL SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 CAHOON RD N
JACKSONVILLE FL
32220-2532
US

IV. Provider business mailing address

763 CAHOON RD N
JACKSONVILLE FL
32220-2532
US

V. Phone/Fax

Practice location:
  • Phone: 904-566-6955
  • Fax:
Mailing address:
  • Phone: 904-566-6955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MAR'LEESIA CRAWFORD
Title or Position: OWNER
Credential:
Phone: 904-566-6955