| Emdr Trauma Therapy Center Llc | |
|
1543 Kingsley Ave Ste 14 Orange Park FL 32073-4570 | |
| (904) 375-9679 | |
| (904) 269-0870 |
| Full Name | Emdr Trauma Therapy Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1543 Kingsley Ave Ste 14, Orange Park, Florida |
| Authorized Official Name and Position | Jeannie L Mitchell (PRINCIPLE/OWNER) |
| Authorized Official Contact | 9043759679 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Emdr Trauma Therapy Center Llc 1543 Kingsley Ave Ste 14 Orange Park FL 32073-4570 Ph: (904) 710-7994 | Emdr Trauma Therapy Center Llc 1543 Kingsley Ave Ste 14 Orange Park FL 32073-4570 Ph: (904) 375-9679 |
| NPI Number | 1407474943 |
|---|---|
| Provider Enumeration Date | 07/10/2020 |
| Last Update Date | 07/10/2020 |
| Certification Date | 07/10/2020 |
| Medicare PECOS PAC ID | 8123470192 |
|---|---|
| Medicare Enrollment ID | O20240116002531 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407474943 | NPI | - | NPPES |
| 1114348661 | Other | NPI |
| Provider Name | Cynthia Robyn Kelley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780989434 PECOS PAC ID: 8325373913 Enrollment ID: I20210204001343 |
| Provider Name | Jeannie Mitchell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114348661 PECOS PAC ID: 8022460096 Enrollment ID: I20240116002651 |
| Provider Name | Cokey Yvonne Powell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194050997 PECOS PAC ID: 1052763307 Enrollment ID: I20240123000657 |
| Provider Name | Rieko Higuchi |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568418598 PECOS PAC ID: 3678925849 Enrollment ID: I20240123004945 |
| Provider Name | Susan E Thyng |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437752078 PECOS PAC ID: 4082053897 Enrollment ID: I20240412002032 |
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