Provider Demographics
NPI:1508323783
Name:FARHAT, JAMIE (RMHCI)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:FARHAT
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 OAKLEAF PLANTATION PKWY UNIT 747
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-3609
Mailing Address - Country:US
Mailing Address - Phone:904-318-2878
Mailing Address - Fax:
Practice Address - Street 1:2523 HERSCHEL ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4509
Practice Address - Country:US
Practice Address - Phone:904-405-9469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH15453101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty