MEDICARE: MISS JASJEET K. MAHAL

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

General Provider Information

NPI Number	:	1184099616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JASJEET K. MAHAL

Provider Business Mailing Address
First Line	:	7524 SOUTHSIDE BLVD
Second Line	:	APT. 1315
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7012
Country	:	US
Telephone Number	:	423-552-5185
Fax Number	:

Provider Business Practice Location Address
First Line	:	8301 CYPRESS PLAZA DR
Second Line	:	SUITE 124
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-4420
Country	:	US
Telephone Number	:	904-574-7636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2015
Last Update Date	:	12/09/2015

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Directions to “ MISS JASJEET K. MAHAL ” Practice Location

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