MTB THERAPIST LLC NPI 1003314790

NPI Information

NPI: 1003314790
Provider Name: MTB THERAPIST, LLC
Classification: Counselor - 101YP2500X
Entity Type: Organization

Specialization: Professional

Address:
6034 CHESTER AVE
JACKSONVILLE, FL
ZIP 32217
Phone: (904) 323-2019
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MTB THERAPIST, LLC is a professional counselor in Jacksonville, FL. MTB THERAPIST, LLC NPI is 1003314790. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

6034 CHESTER AVE
JACKSONVILLE, FL
ZIP 32217-264
Phone: (904) 323-2019

The provider's authorized official is Merland Baker .
The authorized official title is Director and has the following contact phone number (904) 323-2019.

The enumeration date for this NPI number is 1/27/2018 and was last updated on 4/5/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101Y00000X	Counselor		15468	FLORIDA	No
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)	15468	FLORIDA	No
3	101YM0800X	Counselor	Mental Health	15468	FLORIDA	No
4	101YP2500X	Counselor	Professional	15468	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	MH15468	OTHER	FLORIDA	261QM0801X - CLINIC/CENTER - MENTAL HEALTH (INCLUDING COMMUNITY MENTAL HEALTH CE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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