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1851407365

NPI Code Detail

MEDICARE: MENTAL HEALTH RESOURCE CENTER INC

MEDICARE: MENTAL HEALTH RESOURCE 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
1	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency
3	283Q00000X	Psychiatric Hospital
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
5	273R00000X	Psychiatric Hospital Unit
6	261QC1500X	Community Health Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	99464	OTHER	FL	MEDICARE PART B ONLY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851407365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENTAL HEALTH RESOURCE CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 19249
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32245-9249
Country	:	US
Telephone Number	:	904-743-1883
Fax Number	:	904-743-5109

Provider Business Practice Location Address
First Line	:	11820 BEACH BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-6670
Country	:	US
Telephone Number	:	904-642-9100
Fax Number	:	904-642-9108

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	ROBERT SOMMERS
Credential	:	PH.D.
Telephone Number	:	904-743-1883

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	12/15/2022

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1669543526 — RISA SHULER DORIA MSN, ARNP, CS
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1922161785 — MRS. ALISON BOEHNKE BS
Practice Location Address:

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1215078803 — MS. AMY MARIE NELSON LMHC
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Directions to “MENTAL HEALTH RESOURCE CENTER INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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