1285888073 NPI number — ADRIA VAIL PRATT LMHC

Table of content: ADRIA VAIL PRATT LMHC (NPI 1285888073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285888073 NPI number — ADRIA VAIL PRATT LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRATT
Provider First Name:
ADRIA
Provider Middle Name:
VAIL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285888073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 CESERY BLVD
Provider Second Line Business Mailing Address:
SUITE 11
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32211-5674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-716-6184
Provider Business Mailing Address Fax Number:
904-745-3086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6316 SAN JUAN AVE
Provider Second Line Business Practice Location Address:
SUITE 41
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32210-2831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-783-2579
Provider Business Practice Location Address Fax Number:
904-225-1901
Provider Enumeration Date:
11/06/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  MH 10386 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)