Provider Demographics
NPI:1356499917
Name:BOB MCQUEEN, LMHC
Entity Type:Organization
Organization Name:BOB MCQUEEN, LMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUEEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-269-5356
Mailing Address - Street 1:11154 WETHERSFIELD CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-4524
Mailing Address - Country:US
Mailing Address - Phone:904-269-5356
Mailing Address - Fax:904-269-2088
Practice Address - Street 1:1950 MILLER ST STE 6
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4760
Practice Address - Country:US
Practice Address - Phone:904-269-5356
Practice Address - Fax:904-269-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1808101YA0400X
FLMH-4271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty