Healthcare Provider Details

I. General information

NPI: 1356499917
Provider Name (Legal Business Name): BOB MCQUEEN, LMHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 MILLER ST STE 6
ORANGE PARK FL
32073-4760
US

IV. Provider business mailing address

11154 WETHERSFIELD CT
JACKSONVILLE FL
32257-4524
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-5356
  • Fax: 904-269-2088
Mailing address:
  • Phone: 904-269-5356
  • Fax: 904-269-2088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1808
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH-4271
License Number StateFL

VIII. Authorized Official

Name: MR. BOB MCQUEEN
Title or Position: PRESIDENT
Credential: LMHC
Phone: 904-269-5356