MEDICARE: PERSONAL DEVELOPMENT THERAPY 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	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1922777176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONAL DEVELOPMENT THERAPY LLC

Provider Business Mailing Address
First Line	:	7545 CENTURION PKWY STE 105
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-4118
Country	:	US
Telephone Number	:	904-373-7959
Fax Number	:

Provider Business Practice Location Address
First Line	:	7545 CENTURION PKWY STE 105
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-4118
Country	:	US
Telephone Number	:	904-373-7959
Fax Number	:

Authorized Official
Title or Position	:	CLINICIAN
Name	:	ANA MARIA FELIX TORRES
Credential	:	LMHC
Telephone Number	:	904-373-7959

Provider Enumeration Date	:	09/10/2021
Last Update Date	:	01/27/2023

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