MEDICARE: MR. VERLON COY BRICKEY JR. PHD., LMHC, CAP

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	101YP2500X	Professional Counselor	MH5088	FL

General Provider Information

NPI Number	:	1518015700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VERLON COY BRICKEY JR. PHD., LMHC, CAP

Provider Business Mailing Address
First Line	:	2520 UNIVERSITY BLVD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2004
Country	:	US
Telephone Number	:	904-733-1444
Fax Number	:	904-733-5258

Provider Business Practice Location Address
First Line	:	2520 UNIVERSITY BLVD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2004
Country	:	US
Telephone Number	:	904-733-1444
Fax Number	:	904-733-5258

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

Provider Enumeration Date	:	01/06/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. VERLON COY BRICKEY JR. PHD., LMHC, CAP” Practice Location

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