Provider Demographics
NPI:1497363923
Name:STANDBERRY, PAULA (LMHC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:STANDBERRY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4803 CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-1847
Mailing Address - Country:US
Mailing Address - Phone:904-535-4072
Mailing Address - Fax:
Practice Address - Street 1:4803 CHURCHILL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-1847
Practice Address - Country:US
Practice Address - Phone:904-535-4072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21681101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health