Provider Demographics
NPI:1790162535
Name:JESSICA CARTER O'BRIEN
Entity Type:Organization
Organization Name:JESSICA CARTER O'BRIEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:CARTER
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:904-349-1710
Mailing Address - Street 1:13000 SAWGRASS VILLAGE CIR
Mailing Address - Street 2:STE 11
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-5016
Mailing Address - Country:US
Mailing Address - Phone:904-280-8555
Mailing Address - Fax:904-285-8562
Practice Address - Street 1:13000 SAWGRASS VILLAGE CIR
Practice Address - Street 2:STE 11
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-5016
Practice Address - Country:US
Practice Address - Phone:904-280-8555
Practice Address - Fax:904-285-8562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10541251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health