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General NPI Number Information
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NPI Number | 1841802683
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Entity Type | Organization
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Legal Business Name | ELIZABETH SOUTHARD, LMHC, LLC
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Dates
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Enumeration Date | 08/22/2020
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Last Update Date | 04/17/2021
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Provider Practice Location Address
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Address Line | 690A W MACCLENNY AVE
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City | MACCLENNY
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State | FL
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Zip | 32063-2080
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Country | US
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Telephone | 904-400-0517
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Fax |
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Provider Business Mailing Address
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Address Line | 5570 HUCKLEBERRY TRL N
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City | MACCLENNY
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State | FL
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Zip | 32063-1803
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Country | US
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Telephone | 904-885-9948
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARY ELIZABETH SOUTHARD
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Credential | LMHC
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Telephone | 904-400-0517
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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 |
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License Number State |
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