MEDICARE: JTS HOPE AND HEALING WELLNESS CENTER

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	:	1699542910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JTS HOPE AND HEALING WELLNESS CENTER

Provider Business Mailing Address
First Line	:	237 LINDENWOOD CIR W
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-4618
Country	:	US
Telephone Number	:	386-283-6331
Fax Number	:

Provider Business Practice Location Address
First Line	:	1138 W GRANADA BLVD
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5913
Country	:	US
Telephone Number	:	386-283-6331
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH COUNSELOR
Name	:	MRS. TERESA STEVENSON
Credential	:	LMHC
Telephone Number	:	386-283-6331

Provider Enumeration Date	:	12/06/2023
Last Update Date	:	12/07/2023

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