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General NPI Number Information
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NPI Number | 1366089641
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Entity Type | Organization
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Legal Business Name | PROPHETIC HEALING DELIVERANCE MINISTRY OF MYSTERIES, INC
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Dates
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Enumeration Date | 12/05/2019
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Last Update Date | 12/05/2019
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Provider Practice Location Address
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Address Line | 8550-2 LONE STAR ROAD
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City | JACKSONVILLE
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State | FL
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Zip | 32211
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Country | US
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Telephone | 904-257-3769
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Fax |
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Provider Business Mailing Address
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Address Line | 2943 SEARCHWOOD DR
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City | JACKSONVILLE
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State | FL
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Zip | 32277-3435
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Country | US
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Telephone | 561-752-6141
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. JUNO AKBAR
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Credential | DDIV
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Telephone | 904-257-3769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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