Provider Demographics
NPI:1265843734
Name:VERLON C. BRICKEY, PHD.,P.A.
Entity Type:Organization
Organization Name:VERLON C. BRICKEY, PHD.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERLON
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-502-6352
Mailing Address - Street 1:13241 BARTRAM PARK BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5212
Mailing Address - Country:US
Mailing Address - Phone:904-363-6999
Mailing Address - Fax:904-363-6996
Practice Address - Street 1:13241 BARTRAM PARK BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5212
Practice Address - Country:US
Practice Address - Phone:904-363-6999
Practice Address - Fax:904-363-6996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-18
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5088101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty