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General NPI Number Information
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NPI Number | 1710477484
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Entity Type | Organization
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Legal Business Name | TRUSTINGHIM
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Dates
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Enumeration Date | 05/17/2018
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Last Update Date | 08/13/2018
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Provider Practice Location Address
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Address Line | 6789 SOUTHPOINT PKWY STE 100
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City | JACKSONVILLE
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State | FL
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Zip | 32216
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Country | US
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Telephone | 904-556-7330
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Fax |
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Provider Business Mailing Address
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Address Line | 1808 FOREST GLEN WAY
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-1003
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Country | US
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Telephone | 904-477-7568
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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 | MRS. MELISSA KRAMER
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Credential |
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Telephone | 904-556-7330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1366884009
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License Number State | FL
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