Healthcare Provider Details

I. General information

NPI: 1851407365
Provider Name (Legal Business Name): MENTAL HEALTH RESOURCE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11820 BEACH BLVD
JACKSONVILLE FL
32246-6670
US

IV. Provider business mailing address

PO BOX 19249
JACKSONVILLE FL
32245-9249
US

V. Phone/Fax

Practice location:
  • Phone: 904-642-9100
  • Fax: 904-642-9108
Mailing address:
  • Phone: 904-743-1883
  • Fax: 904-743-5109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT SOMMERS
Title or Position: PRESIDENT/CEO
Credential: PH.D.
Phone: 904-743-1883