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General NPI Number Information
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NPI Number | 1972330272
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Entity Type | Organization
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Legal Business Name | PHOENIX BEHAVIORAL HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 09/19/2024
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 9109 BAYMEADOWS RD STE 3
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City | JACKSONVILLE
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State | FL
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Zip | 32256-1842
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Country | US
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Telephone | 904-227-2280
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Fax |
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Provider Business Mailing Address
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Address Line | 9109 BAYMEADOWS RD STE 3
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City | JACKSONVILLE
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State | FL
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Zip | 32256-1842
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Country | US
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Telephone | 904-227-2280
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHERMERA YVONNE SMITH
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Credential |
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Telephone | 904-227-2280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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