Provider Demographics
NPI:1184308108
Name:CRAFT BEHAVIORAL HEALTH CLINIC
Entity type:Organization
Organization Name:CRAFT BEHAVIORAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROOQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:904-379-5928
Mailing Address - Street 1:10175 FORTUNE PKWY UNIT 1106
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6757
Mailing Address - Country:US
Mailing Address - Phone:904-337-0768
Mailing Address - Fax:904-379-5967
Practice Address - Street 1:10175 FORTUNE PKWY UNIT 1106
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6757
Practice Address - Country:US
Practice Address - Phone:904-337-0768
Practice Address - Fax:904-379-5967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374700000XNursing Service Related ProvidersTechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEO2233OtherDEPARTMENT OF HEALTH ELECTROLOGIST LICENSE