Provider Demographics
NPI:1134577901
Name:NAUTILUS BEHAVIORAL HEALTH, PLLC
Entity type:Organization
Organization Name:NAUTILUS BEHAVIORAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/LICENSED CLINICAL PSYCHOLO
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DEW-REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-432-3321
Mailing Address - Street 1:12412 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8621
Mailing Address - Country:US
Mailing Address - Phone:904-432-3321
Mailing Address - Fax:904-432-3324
Practice Address - Street 1:12412 SAN JOSE BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8621
Practice Address - Country:US
Practice Address - Phone:904-432-3321
Practice Address - Fax:904-432-3324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9064103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty