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General NPI Number Information
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NPI Number | 1265473409
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Entity Type | Individual
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Provider Name | JOHN MIHALOVICH PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 614 NE JENSEN BEACH BLVD
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City | JENSEN BEACH
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State | FL
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Zip | 34957-4750
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Country | US
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Telephone | 772-370-9836
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Fax | 772-225-1226
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Provider Business Mailing Address
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Address Line | 2850 SE CALVIN ST
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-5808
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Country | US
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Telephone | 772-335-5505
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PY0002766
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PY0002766
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY0002766
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License Number State | FL
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