Provider Demographics
NPI:1346210440
Name:MORELAND, JOHN (PHD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:MORELAND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14011 BEACH BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-1507
Mailing Address - Country:US
Mailing Address - Phone:904-223-4865
Mailing Address - Fax:904-223-4868
Practice Address - Street 1:14011 BEACH BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-1507
Practice Address - Country:US
Practice Address - Phone:904-223-4865
Practice Address - Fax:904-223-4868
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3479103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75578Medicare ID - Type Unspecified