Provider Demographics
NPI:1770631269
Name:PALLAY, PATRICIA JO (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:JO
Last Name:PALLAY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-4764
Mailing Address - Country:US
Mailing Address - Phone:904-346-5100
Mailing Address - Fax:904-346-5111
Practice Address - Street 1:4600 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4764
Practice Address - Country:US
Practice Address - Phone:904-346-5100
Practice Address - Fax:904-346-5111
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5326101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health