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General NPI Number Information
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NPI Number | 1528005311
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL SERVICES OF JACKSONVILLE LLC
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 358 STILES AVE SUITE B
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City | ORANGE PARK
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State | FL
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Zip | 32073-4012
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Country | US
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Telephone | 904-264-8311
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Fax | 904-264-8377
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Provider Business Mailing Address
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Address Line | 358 STILES AVE STE B
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City | ORANGE PARK
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State | FL
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Zip | 32073-4012
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Country | US
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Telephone | 904-264-8311
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Fax | 904-264-8377
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | HEATHER KUIPER
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Credential |
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Telephone | 904-264-8311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY-7122
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License Number State | FL
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