Healthcare Provider Details

I. General information

NPI: 1770953507
Provider Name (Legal Business Name): JAMES E URBAN LMHC, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 PARK AVENUE BUILDING 500 SUITE 103
ORANGE PARK FL
32073
US

IV. Provider business mailing address

2233 PARK AVENUE BUILDING 500 SUITE 103
ORANGE PARK FL
32073
US

V. Phone/Fax

Practice location:
  • Phone: 904-596-0496
  • Fax:
Mailing address:
  • Phone: 904-596-0496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006313
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16459
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: