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General NPI Number Information
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NPI Number | 1780193094
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH JAX
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Dates
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Enumeration Date | 09/29/2017
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Last Update Date | 09/29/2017
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Provider Practice Location Address
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Address Line | 8825 PERIMETER PARK BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1108
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Country | US
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Telephone | 904-860-8749
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Fax |
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Provider Business Mailing Address
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Address Line | 16927 ETHEL RD
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City | JACKSONVILLE
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State | FL
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Zip | 32218-1107
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARGARET M GHEE
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Credential | LMHC
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Telephone | 904-860-8749
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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 | MH5145
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License Number State | FL
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