Provider Demographics
NPI:1922247501
Name:THE BODY IMAGE COUNSELING CENTER
Entity Type:Organization
Organization Name:THE BODY IMAGE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:OSACHY
Authorized Official - Suffix:
Authorized Official - Credentials:MSS
Authorized Official - Phone:904-737-3232
Mailing Address - Street 1:1545 LANDON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8671
Mailing Address - Country:US
Mailing Address - Phone:904-737-3232
Mailing Address - Fax:904-396-4505
Practice Address - Street 1:1545 LANDON AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8671
Practice Address - Country:US
Practice Address - Phone:904-737-3232
Practice Address - Fax:904-396-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW5916251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health