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General NPI Number Information
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NPI Number | 1598137994
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Entity Type | Organization
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Legal Business Name | MINDFULNESS COUNSELING CENTER OF JACKSONVILLE
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Dates
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Enumeration Date | 10/24/2015
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Last Update Date | 10/24/2015
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Provider Practice Location Address
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Address Line | 2380 3RD ST S SUITE 2
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-4072
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Country | US
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Telephone | 904-599-3099
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Fax | 904-713-2967
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Provider Business Mailing Address
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Address Line | 2380 3RD ST S SUITE 2
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-4072
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Country | US
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Telephone | 904-599-3099
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Fax | 904-713-2967
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | JULIE INGBER
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Credential | LMHC
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Telephone | 904-686-5018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 7855MH
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License Number State | FL
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