Provider Demographics
NPI:1699815175
Name:PRICE, POLLY JO (LMHC)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:JO
Last Name:PRICE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:POLLY
Other - Middle Name:JO
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4160 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4317
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:904-396-8966
Practice Address - Street 1:13241 BARTRAM PARK BLVD
Practice Address - Street 2:SUITE 1901
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5212
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:904-396-8971
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6045101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health