Healthcare Provider Details

I. General information

NPI: 1477715068
Provider Name (Legal Business Name): KATHLEEN PATNEAU LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4203 BELFORT RD STE 250
JACKSONVILLE FL
32216-1416
US

IV. Provider business mailing address

PO BOX 2711
PONTE VEDRA FL
32004-2711
US

V. Phone/Fax

Practice location:
  • Phone: 904-308-3751
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2317
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: