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General NPI Number Information
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NPI Number | 1063228559
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Entity Type | Organization
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Legal Business Name | HYATT HAVEN MENTAL HEALTH CLINIC
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 2140 KINGSLEY AVE STE 8
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City | ORANGE PARK
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State | FL
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Zip | 32073-5129
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Country | US
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Telephone | 904-742-8623
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Fax |
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Provider Business Mailing Address
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Address Line | 630 PLAINFIELD AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-2916
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Country | US
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Telephone | 904-742-8623
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. JACQUELYN HYATT
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Credential | PHARMD
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Telephone | 904-742-8623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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