1255651766 NPI number — MS. JANE YOUNG ARTHUR LCSW

Table of content: MS. JANE YOUNG ARTHUR LCSW (NPI 1255651766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255651766 NPI number — MS. JANE YOUNG ARTHUR LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARTHUR
Provider First Name:
JANE
Provider Middle Name:
YOUNG
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WORKX
Provider Other First Name:
WELLNESS
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LLC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1255651766
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2028
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAND O LAKES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34639-2028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-504-1462
Provider Business Mailing Address Fax Number:
813-996-9705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3632 LAND O LAKES BLVD
Provider Second Line Business Practice Location Address:
SUITE 106-5
Provider Business Practice Location Address City Name:
LAND O LAKES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34639-4405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-504-1462
Provider Business Practice Location Address Fax Number:
813-996-9705
Provider Enumeration Date:
06/07/2010

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: 1041C0700X , with the licence number:  SW2312 , 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)

  • Identifier: 10745043 . This is a "COUNCIL FOR AFFORDABLE QUALITY HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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