Provider Demographics
NPI:1376941310
Name:NEUROBEHAVIORAL SPECIALISTS OF JACKSONVILLE INC
Entity Type:Organization
Organization Name:NEUROBEHAVIORAL SPECIALISTS OF JACKSONVILLE INC
Other - Org Name:NBS-JAX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PROSJE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:352-682-0060
Mailing Address - Street 1:4110 SOUTHPOINT BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-0927
Mailing Address - Country:US
Mailing Address - Phone:352-682-0060
Mailing Address - Fax:
Practice Address - Street 1:4110 SOUTHPOINT BLVD STE 212
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0927
Practice Address - Country:US
Practice Address - Phone:352-682-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8710103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty