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General NPI Number Information
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NPI Number | 1083462444
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Entity Type | Individual
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Provider Name | MATTHEW BREWER LMHC
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Gender | Male
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Dates
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Enumeration Date | 05/10/2024
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 2055 REYKO RD STE 100
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City | JACKSONVILLE
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State | FL
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Zip | 32207-2822
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Country | US
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Telephone | 368-747-2338
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Fax |
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Provider Business Mailing Address
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Address Line | 13014 SUNSET LAKE DR
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City | JACKSONVILLE
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State | FL
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Zip | 32258-8439
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Country | US
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Telephone | 386-747-2338
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH23672
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License Number State | FL
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