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General NPI Number Information
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NPI Number | 1720326382
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Entity Type | Organization
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Legal Business Name | FIRST COAST BEHAVIOR SOLUTIONS, LLC
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Dates
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Enumeration Date | 01/16/2013
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Last Update Date | 09/11/2018
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Provider Practice Location Address
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Address Line | 2317 BLANDING BLVD STE 102
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City | JACKSONVILLE
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State | FL
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Zip | 32210
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Country | US
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Telephone | 904-200-7979
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Fax | 904-387-5890
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Provider Business Mailing Address
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Address Line | 2317 BLANDING BLVD STE 102
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City | JACKSONVILLE
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State | FL
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Zip | 32210-4167
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Country | US
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Telephone | 904-200-7979
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Fax |
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Authorized Official
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Title or Position | OWNER/ CLINICAL DIRECTOR
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Name | KIMBERLY CRUISE
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Credential | LMHC, BCABA
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Telephone | 904-476-8956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH-10245
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License Number State | FL
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