Healthcare Provider Details

I. General information

NPI: 1760005599
Provider Name (Legal Business Name): PUZZLING PATTERNS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8649 A C SKINNER PKWY APT 607
JACKSONVILLE FL
32256-7880
US

IV. Provider business mailing address

PO BOX 551675
JACKSONVILLE FL
32255-1675
US

V. Phone/Fax

Practice location:
  • Phone: 404-697-3608
  • Fax:
Mailing address:
  • Phone: 404-697-3608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: CHARITY CROWELL
Title or Position: OWNER
Credential:
Phone: 404-697-3608