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NPI Code Detail

MEDICARE: CHILD GUIDANCE CENTER, INC.

MEDICARE: CHILD GUIDANCE CENTER, INC.
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629646450
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHILD GUIDANCE CENTER, INC.
Provider Business Mailing Address
First Line : 5776 SAINT AUGUSTINE RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8046
Country : US
Telephone Number : 904-400-6739
Fax Number :
Provider Business Practice Location Address
First Line : 1110 EDGEWOOD AVE W
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32208-6405
Country : US
Telephone Number : 904-448-4700
Fax Number :
Authorized Official
Title or Position : CHIEF CLINICAL OFFICER
Name : BETH ELLEN OBERLANDER
Credential :
Telephone Number : 904-400-6739
Provider Enumeration Date : 06/17/2021
Last Update Date : 06/17/2021

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Directions to “CHILD GUIDANCE CENTER, INC. ” Practice Location

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