Healthcare Provider Details

I. General information

NPI: 1538904933
Provider Name (Legal Business Name): HEALING HEART BEHAVIORAL CONSULTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 BARTRAM MARKET DR STE 135
SAINT JOHNS FL
32259-4583
US

IV. Provider business mailing address

155 BARTRAM MARKET DR STE 135
SAINT JOHNS FL
32259-4583
US

V. Phone/Fax

Practice location:
  • Phone: 904-257-6327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHICARA IRVIN
Title or Position: OWNER/CEO
Credential: NP
Phone: 904-257-6327