Healthcare Provider Details

I. General information

NPI: 1699815175
Provider Name (Legal Business Name): POLLY JO PRICE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: POLLY JO MITCHELL

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 KINGSLEY AVE STE 101
ORANGE PARK FL
32073-9201
US

IV. Provider business mailing address

1555 KINGSLEY AVE STE 101
ORANGE PARK FL
32073-9201
US

V. Phone/Fax

Practice location:
  • Phone: 904-278-4999
  • Fax: 833-449-5208
Mailing address:
  • Phone: 904-278-4999
  • Fax: 833-449-5208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH6045
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: