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General NPI Number Information
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NPI Number | 1235595380
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Entity Type | Organization
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Legal Business Name | CONNECTED COUNSELOR LLC
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Dates
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Enumeration Date | 01/05/2016
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Last Update Date | 07/25/2019
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Provider Practice Location Address
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Address Line | 4540 SOUTHSIDE BLVD STE 604
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City | JACKSONVILLE
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State | FL
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Zip | 32216-5488
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Country | US
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Telephone | 904-299-2928
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Fax | 904-800-1331
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Provider Business Mailing Address
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Address Line | 4540 SOUTHSIDE BLVD STE 604
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City | JACKSONVILLE
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State | FL
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Zip | 32216-5488
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Country | US
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Telephone | 904-299-2928
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Fax | 904-800-1331
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Authorized Official
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Title or Position | OWNER
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Name | ALLISON TEGER
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Credential |
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Telephone | 904-299-2928
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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 | MH7665
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License Number State | FL
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