Healthcare Provider Details

I. General information

NPI: 1629468376
Provider Name (Legal Business Name): MENTAL HEALTH AMERICA OF NORTHEAST FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 PHILIPS HWY STE 300
JACKSONVILLE FL
32207-9506
US

IV. Provider business mailing address

4615 PHILIPS HWY STE 300
JACKSONVILLE FL
32207-9506
US

V. Phone/Fax

Practice location:
  • Phone: 904-738-8420
  • Fax: 904-862-2109
Mailing address:
  • Phone: 904-738-8420
  • Fax: 904-862-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. WENDY LEIGH HUGHES
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CPA, CRPS
Phone: 904-342-9200