Healthcare Provider Details

I. General information

NPI: 1972220481
Provider Name (Legal Business Name): JESSICA R METZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 KINGSLEY AVE STE 113
ORANGE PARK FL
32073-4586
US

IV. Provider business mailing address

677 ARTHUR MOORE DR
GREEN COVE SPRINGS FL
32043-9530
US

V. Phone/Fax

Practice location:
  • Phone: 904-458-7780
  • Fax:
Mailing address:
  • Phone: 904-651-3597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH24757
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: