Healthcare Provider Details

I. General information

NPI: 1114556776
Provider Name (Legal Business Name): JESSICA HOBGOOD LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 GERONA RD
ST AUGUSTINE FL
32086-6112
US

IV. Provider business mailing address

135 JENKINS STREET, STE 105-B #177
ST. AUGUSTINE FL
32086
US

V. Phone/Fax

Practice location:
  • Phone: 904-494-8393
  • Fax:
Mailing address:
  • Phone: 904-494-8393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH17568
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: