Healthcare Provider Details

I. General information

NPI: 1831510304
Provider Name (Legal Business Name): PSYCHOEDUCATIONAL CONSULTANT GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2013
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 SUTTON PARK CT SUITE 802
JACKSONVILLE FL
32224-0250
US

IV. Provider business mailing address

4745 SUTTON PARK CT SUITE 802
JACKSONVILLE FL
32224-0250
US

V. Phone/Fax

Practice location:
  • Phone: 904-874-6164
  • Fax:
Mailing address:
  • Phone: 904-874-6164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS873
License Number StateFL

VIII. Authorized Official

Name: PATRICK EDWARD HUGHES
Title or Position: SCHOOL PSYCHOLOGIST
Credential: ED.S.
Phone: 904-874-6164