Provider Demographics
NPI:1629468376
Name:MENTAL HEALTH AMERICA OF NORTHEAST FLORIDA, INC.
Entity Type:Organization
Organization Name:MENTAL HEALTH AMERICA OF NORTHEAST FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, CRPS
Authorized Official - Phone:904-342-9200
Mailing Address - Street 1:4615 PHILIPS HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-9506
Mailing Address - Country:US
Mailing Address - Phone:904-738-8420
Mailing Address - Fax:904-862-2109
Practice Address - Street 1:4615 PHILIPS HWY STE 300
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-9506
Practice Address - Country:US
Practice Address - Phone:904-738-8420
Practice Address - Fax:904-862-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Single Specialty