=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619888617
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. BRIAN CELSO, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2026
-----------------------------------------------------
Last Update Date | 09/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4114 HERSCHEL ST STE 110
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32210-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-210-1130
-----------------------------------------------------
Fax | 904-374-3192
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2775 SAINT JOHNS AVE APT 5
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32205-8260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-210-1130
-----------------------------------------------------
Fax | 904-374-3192
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BRIAN G CELSO
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 904-210-1130
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------