Provider Demographics
NPI:1205305596
Name:HOWELL, NATHANIAL JAMAL
Entity type:Individual
Prefix:MR
First Name:NATHANIAL
Middle Name:JAMAL
Last Name:HOWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SHETTER AVE APT 6304
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3462
Mailing Address - Country:US
Mailing Address - Phone:205-863-7898
Mailing Address - Fax:
Practice Address - Street 1:9000 CYPRESS GREEN DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7791
Practice Address - Country:US
Practice Address - Phone:904-732-4343
Practice Address - Fax:904-732-4344
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician