| Elizabeth Southard, Lmhc, Llc | |
|
690a W Macclenny Ave Macclenny FL 32063-2080 | |
| (904) 400-0517 | |
| Not Available |
| Full Name | Elizabeth Southard, Lmhc, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 690a W Macclenny Ave, Macclenny, Florida |
| Authorized Official Name and Position | Mary Elizabeth Southard (OWNER) |
| Authorized Official Contact | 9044000517 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elizabeth Southard, Lmhc, Llc 5570 Huckleberry Trl N Macclenny FL 32063-1803 Ph: (904) 885-9948 | Elizabeth Southard, Lmhc, Llc 690a W Macclenny Ave Macclenny FL 32063-2080 Ph: (904) 400-0517 |
| NPI Number | 1841802683 |
|---|---|
| Provider Enumeration Date | 08/22/2020 |
| Last Update Date | 04/17/2021 |
| Certification Date | 04/17/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841802683 | NPI | - | NPPES |
| 021509900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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