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General NPI Number Information
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NPI Number | 1992576284
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Entity Type | Organization
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Legal Business Name | NORTH FLORIDA PSYCHOTHERAPY
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Dates
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Enumeration Date | 01/15/2024
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Last Update Date | 01/15/2024
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Provider Practice Location Address
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Address Line | 4016 3RD ST S STE 1159
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-5848
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Country | US
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Telephone | 904-373-8328
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Fax |
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Provider Business Mailing Address
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Address Line | 4016 3RD ST S STE 1159
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-5848
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Country | US
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Telephone | 904-373-8328
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTEN KELLEY
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Credential | PSY D
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Telephone | 904-373-8328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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