Healthcare Provider Details

I. General information

NPI: 1912825159
Provider Name (Legal Business Name): THE MUSTARD SEED BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2866 BELAIR RD E
JACKSONVILLE FL
32207-4452
US

IV. Provider business mailing address

2866 BELAIR RD E
JACKSONVILLE FL
32207-4452
US

V. Phone/Fax

Practice location:
  • Phone: 904-206-7208
  • Fax:
Mailing address:
  • Phone: 904-206-7208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ADRIANA N WHEELER
Title or Position: AMBR
Credential: BCABA
Phone: 904-776-0455