Provider Demographics
NPI:1619741154
Name:MEHTA PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:MEHTA PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BHUMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-901-9184
Mailing Address - Street 1:2142 INTRACOASTAL SOUND DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1367
Mailing Address - Country:US
Mailing Address - Phone:904-901-9184
Mailing Address - Fax:
Practice Address - Street 1:13245 ATLANTIC BLVD STE 4-328
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7121
Practice Address - Country:US
Practice Address - Phone:904-901-9184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty