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General NPI Number Information
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NPI Number | 1194016121
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Entity Type | Individual
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Provider Name | CHET T. HEIN LMHC
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Gender | Male
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Dates
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Enumeration Date | 04/25/2011
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Last Update Date | 04/25/2011
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Provider Practice Location Address
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Address Line | 10175 FORTUNE PKWY SUITE 1106
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6746
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Country | US
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Telephone | 904-379-5928
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Fax | 904-379-5967
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Provider Business Mailing Address
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Address Line | 1329 GARRISON DR
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092-1072
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Country | US
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Telephone | 904-303-3834
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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 | MH 10544
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License Number State | FL
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