Healthcare Provider Details

I. General information

NPI: 1205247780
Provider Name (Legal Business Name): EMILY B RIEGEL M ED LMHC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2014
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 MARSH LANDING BLVD STE 104
PONTE VEDRA BEACH FL
32082-1287
US

IV. Provider business mailing address

4400 MARSH LANDING BLVD STE 104
PONTE VEDRA BEACH FL
32082-1287
US

V. Phone/Fax

Practice location:
  • Phone: 904-834-4433
  • Fax:
Mailing address:
  • Phone: 904-834-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH3390
License Number StateFL

VIII. Authorized Official

Name: EMILY BANKS RIEGEL
Title or Position: OWNER
Credential: L.M.H.C.
Phone: 904-834-4433