MEDICARE: OPEN AIR WELLNESS, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1518804194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN AIR WELLNESS, LLC

Provider Business Mailing Address
First Line	:	333 1ST ST N STE 200
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-6939
Country	:	US
Telephone Number	:	772-321-9180
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 1ST ST N STE 200
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-6939
Country	:	US
Telephone Number	:	772-321-9180
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MICHAEL J ANSLEY
Credential	:	LCSW
Telephone Number	:	772-321-9180

Provider Enumeration Date	:	05/01/2026
Last Update Date	:	05/04/2026

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Directions to “OPEN AIR WELLNESS, LLC ” Practice Location

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