| Discovery Mental Health Services | |
|
13453 N Main St Ste 104 Jacksonville FL 32218-2773 | |
| (904) 773-4390 | |
| (941) 621-7089 |
| Full Name | Discovery Mental Health Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 13453 N Main St Ste 104, Jacksonville, Florida |
| Authorized Official Name and Position | Kelly Lane Stevens (OWNER) |
| Authorized Official Contact | 9042946277 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Discovery Mental Health Services 13453 N Main St Ste 104 Jacksonville FL 32218-2773 Ph: (904) 773-4390 | Discovery Mental Health Services 13453 N Main St Ste 104 Jacksonville FL 32218-2773 Ph: (904) 773-4390 |
| NPI Number | 1023697745 |
|---|---|
| Provider Enumeration Date | 04/08/2021 |
| Last Update Date | 02/23/2024 |
| Certification Date | 02/23/2024 |
| Medicare PECOS PAC ID | 7113310939 |
|---|---|
| Medicare Enrollment ID | O20220131001070 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023697745 | NPI | - | NPPES |
| 11501600 | Medicaid | FL | |
| OV824 | Other | FL | MEDICARE |
| Provider Name | Michael A Coulter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194031880 PECOS PAC ID: 0547386021 Enrollment ID: I20100922000790 |
| Provider Name | Billie A Beech Mavrantzas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982055505 PECOS PAC ID: 9032496914 Enrollment ID: I20170502000923 |
| Provider Name | Tasha Ellsberry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013466697 PECOS PAC ID: 5698168375 Enrollment ID: I20220201000857 |
| Provider Name | Shanton Roberson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740726355 PECOS PAC ID: 9436501194 Enrollment ID: I20240118000095 |
| Provider Name | Kelly Stevens |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1861900458 PECOS PAC ID: 3577956309 Enrollment ID: I20240130001881 |
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