Provider Demographics
NPI:1740210574
Name:KEREKES, CHARLES VAUGHN (LMFT, LMHC, CAP)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:VAUGHN
Last Name:KEREKES
Suffix:
Gender:M
Credentials:LMFT, LMHC, CAP
Other - Prefix:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL HOSPITAL JACKSONVILLE
Mailing Address - Street 2:2080 CHILD STREET
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32214-0001
Mailing Address - Country:US
Mailing Address - Phone:904-542-3473
Mailing Address - Fax:904-542-2932
Practice Address - Street 1:NAVAL HOSPITAL JACKSONVILLE SARP
Practice Address - Street 2:2034 TATUM AVENUE
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214-0001
Practice Address - Country:US
Practice Address - Phone:904-542-3473
Practice Address - Fax:904-542-2932
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLMH2406101YM0800X, 101YP2500X
FLMT2093106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional