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General NPI Number Information
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NPI Number | 1164965158
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Entity Type | Organization
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Legal Business Name | THERAPY-INTERVENTIONS
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Dates
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Enumeration Date | 11/23/2016
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Last Update Date | 11/23/2016
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Provider Practice Location Address
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Address Line | 10752 DEERWOOD PARK BLVD SUITE
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City | JACKSONVILLE
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State | FL
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Zip | 32256-4849
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Country | US
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Telephone | 904-394-2868
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Fax | 904-394-2869
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Provider Business Mailing Address
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Address Line | 10752 DEERWOOD PARK BLVD SUITE
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City | JACKSONVILLE
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State | FL
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Zip | 32256-4849
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Country | US
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Telephone | 904-394-2868
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Fax | 904-394-2869
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH THERAPIST
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Name | COLLEEN HILL WRIGHT
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Credential | LMHC
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Telephone | 904-394-2868
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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 | MH9809
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License Number State | FL
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