Healthcare Provider Details

I. General information

NPI: 1417609645
Provider Name (Legal Business Name): OWIMAST HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10245 CENTURION PKWY N STE 250
JACKSONVILLE FL
32256-0561
US

IV. Provider business mailing address

10245 CENTURION PKWY N STE 250
JACKSONVILLE FL
32256-0561
US

V. Phone/Fax

Practice location:
  • Phone: 904-674-3521
  • Fax:
Mailing address:
  • Phone: 904-674-3521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ERIN PASH
Title or Position: OWNER
Credential: LMFT
Phone: 904-674-3521