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General NPI Number Information
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NPI Number | 1245031582
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Entity Type | Organization
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Legal Business Name | J&K MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 03/22/2025
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Last Update Date | 03/22/2025
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Provider Practice Location Address
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Address Line | 13453 N MAIN ST STE 104
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City | JACKSONVILLE
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State | FL
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Zip | 32218-2773
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Country | US
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Telephone | 904-773-4390
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Fax | 941-621-7089
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Provider Business Mailing Address
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Address Line | 2211 CAVALRY BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32246-4202
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Country | US
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Telephone | 904-294-6277
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY L STEVENS
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Credential | MA, LMFT
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Telephone | 904-294-6277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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