Provider Demographics
NPI:1467547091
Name:BEHAVIORAL ARTS & RESEARCH CLINIC L
Entity Type:Organization
Organization Name:BEHAVIORAL ARTS & RESEARCH CLINIC L
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-371-4948
Mailing Address - Street 1:11798 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223
Mailing Address - Country:US
Mailing Address - Phone:904-371-4948
Mailing Address - Fax:904-371-4958
Practice Address - Street 1:11798 SAN JOSE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223
Practice Address - Country:US
Practice Address - Phone:904-371-4948
Practice Address - Fax:904-371-4958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7115103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty