Provider Demographics
NPI:1235152604
Name:BIOFEEDBACK ASSOCIATES OF NE FL
Entity Type:Organization
Organization Name:BIOFEEDBACK ASSOCIATES OF NE FL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:THARP-WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC, NCC
Authorized Official - Phone:904-646-0054
Mailing Address - Street 1:11512 LAKE MEAD AVE
Mailing Address - Street 2:SUITE 703
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-646-0054
Mailing Address - Fax:904-646-0930
Practice Address - Street 1:11512 LAKE MEAD AVE
Practice Address - Street 2:SUITE 703
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-646-0054
Practice Address - Fax:904-646-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2969101YM0800X
FLMH6843101YM0800X
FLMH5155101YM0800X
FLMH5132101YM0800X
FLMH4616101YM0800X
FLSW2527101YM0800X
FLSW1447101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty