MEDICARE: TRACY RILEY COUNSELING 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1306234950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRACY RILEY COUNSELING LLC

Provider Business Mailing Address
First Line	:	3545 SAINT JOHNS BLUFF RD S UNIT 1-252
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-2682
Country	:	US
Telephone Number	:	904-704-2527
Fax Number	:

Provider Business Practice Location Address
First Line	:	3410 KORI RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5454
Country	:	US
Telephone Number	:	904-704-2527
Fax Number	:	866-384-3669

Authorized Official
Title or Position	:	OWNER
Name	:	TRACY M RILEY
Credential	:
Telephone Number	:	904-704-2527

Provider Enumeration Date	:	01/06/2015
Last Update Date	:	12/04/2024

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