Provider Demographics
NPI:1528005311
Name:PSYCHOLOGICAL SERVICES OF JACKSONVILLE LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES OF JACKSONVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:K
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:904-264-8311
Mailing Address - Street 1:358 STILES AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4012
Mailing Address - Country:US
Mailing Address - Phone:904-264-8311
Mailing Address - Fax:904-264-8377
Practice Address - Street 1:358 STILES AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4012
Practice Address - Country:US
Practice Address - Phone:904-264-8311
Practice Address - Fax:904-264-8377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY-7122103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty