MEDICARE: HER BEHAVIORAL HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1013897388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HER BEHAVIORAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	8627 STANMOOR CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-7162
Country	:	US
Telephone Number	:	229-834-1098
Fax Number	:	229-834-1098

Provider Business Practice Location Address
First Line	:	200 N LAURA ST STE 803
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-3502
Country	:	US
Telephone Number	:	229-834-1098
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ DIRECTOR
Name	:	NEKITA LEATHERWOOD
Credential	:
Telephone Number	:	229-834-1098

Provider Enumeration Date	:	09/05/2025
Last Update Date	:	11/17/2025

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