Provider Demographics
NPI:1558048405
Name:JEM THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:JEM THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR/QU
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MATILLA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-773-4665
Mailing Address - Street 1:1409 KINGSLEY AVE,
Mailing Address - Street 2:BLDG 9, SUITE D
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4537
Mailing Address - Country:US
Mailing Address - Phone:904-773-4665
Mailing Address - Fax:904-773-4668
Practice Address - Street 1:1409 KINGSLEY AVE,
Practice Address - Street 2:BLDG 9, SUITE D
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4537
Practice Address - Country:US
Practice Address - Phone:904-773-4665
Practice Address - Fax:904-773-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty