Provider Demographics
NPI:1710477484
Name:TRUSTINGHIM
Entity Type:Organization
Organization Name:TRUSTINGHIM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-556-7330
Mailing Address - Street 1:1808 FOREST GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1003
Mailing Address - Country:US
Mailing Address - Phone:904-477-7568
Mailing Address - Fax:
Practice Address - Street 1:6789 SOUTHPOINT PKWY STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-556-7330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1366884009103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1851712673Medicaid
FL1558345421Medicaid
FL1609267319Medicaid
FL1992126718Medicaid
FL1275089914Medicaid
FL1700323011Medicaid
FL1225450265Medicaid
FL1245749100Medicaid
FL1477717346Medicaid
FL1568841708Medicaid
FL1700178282Medicaid