Healthcare Provider Details

I. General information

NPI: 1164092029
Provider Name (Legal Business Name): MENTAL HEALTH RESOURCE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 SHADOWOOD LN STE 106
JACKSONVILLE FL
32207-2187
US

IV. Provider business mailing address

PO BOX 19249
JACKSONVILLE FL
32245-9249
US

V. Phone/Fax

Practice location:
  • Phone: 904-695-0249
  • Fax: 904-695-7385
Mailing address:
  • Phone: 904-743-1883
  • Fax: 904-743-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
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