Provider Demographics
NPI:1649643099
Name:EMERY, BRIAN (MS, PHD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:EMERY
Suffix:
Gender:M
Credentials:MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 WELLS RD STE 304
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-3037
Mailing Address - Country:US
Mailing Address - Phone:904-720-4040
Mailing Address - Fax:904-720-4596
Practice Address - Street 1:165 WELLS RD STE 304
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-3037
Practice Address - Country:US
Practice Address - Phone:904-720-4040
Practice Address - Fax:904-720-4596
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14212101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health