Provider Demographics
NPI:1104536267
Name:SKY-RISE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:SKY-RISE BEHAVIORAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS HIXON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-314-0569
Mailing Address - Street 1:2255 DUNN AVE STE 601B
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4742
Mailing Address - Country:US
Mailing Address - Phone:904-314-0569
Mailing Address - Fax:
Practice Address - Street 1:2255 DUNN AVE STE 601B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4742
Practice Address - Country:US
Practice Address - Phone:904-314-0569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health