Provider Demographics
NPI:1285198671
Name:PLOTZ, AARON JOHN
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:JOHN
Last Name:PLOTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 GLYNLEA RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2612
Mailing Address - Country:US
Mailing Address - Phone:904-314-7793
Mailing Address - Fax:
Practice Address - Street 1:2301 PARK AVE STE 205
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5558
Practice Address - Country:US
Practice Address - Phone:850-901-9281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLMH22077101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health