Provider Demographics
NPI:1922777176
Name:PERSONAL DEVELOPMENT THERAPY LLC
Entity Type:Organization
Organization Name:PERSONAL DEVELOPMENT THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:FELIX TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-373-7959
Mailing Address - Street 1:7545 CENTURION PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4118
Mailing Address - Country:US
Mailing Address - Phone:904-373-7959
Mailing Address - Fax:
Practice Address - Street 1:7545 CENTURION PKWY STE 105
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4118
Practice Address - Country:US
Practice Address - Phone:904-373-7959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health