Healthcare Provider Details

I. General information

NPI: 1659025864
Provider Name (Legal Business Name): ANTHONY J JONES RMCI IMH13250
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 1ST AVE S
SAINT PETERSBURG FL
33707-1103
US

IV. Provider business mailing address

7301 1ST AVE S
SAINT PETERSBURG FL
33707-1103
US

V. Phone/Fax

Practice location:
  • Phone: 727-623-9070
  • Fax: 727-623-9045
Mailing address:
  • Phone: 727-623-9070
  • Fax: 727-623-9045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberIMH13250
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberIMH13250
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberIMH13250
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH13250
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: