Healthcare Provider Details

I. General information

NPI: 1871909226
Provider Name (Legal Business Name): PUZZLE PEACE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5270 PALM VALLEY RD
PONTE VEDRA FL
32082-3200
US

IV. Provider business mailing address

5270 PALM VALLEY RD
PONTE VEDRA FL
32082-3200
US

V. Phone/Fax

Practice location:
  • Phone: 904-501-3809
  • Fax:
Mailing address:
  • Phone: 904-501-3809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12319
License Number StateFL

VIII. Authorized Official

Name: MS. JANEEN M HERSKOVITZ
Title or Position: OWNER/PRESIDENT
Credential: MA, LMHC
Phone: 904-501-3809