MEDICARE: SKY-RISE BEHAVIORAL HEALTH

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1104536267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKY-RISE BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	2255 DUNN AVE STE 601B
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-4742
Country	:	US
Telephone Number	:	904-314-0569
Fax Number	:

Provider Business Practice Location Address
First Line	:	2255 DUNN AVE STE 601B
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-4742
Country	:	US
Telephone Number	:	904-314-0569
Fax Number	:

Authorized Official
Title or Position	:	LICENSED MENTAL HEALTH COUNSELOR
Name	:	NORMA OWENS HIXON
Credential	:	LMHC
Telephone Number	:	904-314-0569

Provider Enumeration Date	:	11/30/2022
Last Update Date	:	12/02/2022

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