Provider Demographics
NPI:1285884650
Name:FIRST COAST MENTAL HEALTH P A
Entity type:Organization
Organization Name:FIRST COAST MENTAL HEALTH P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:D
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-269-7200
Mailing Address - Street 1:1409 KINGSLEY AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4553
Mailing Address - Country:US
Mailing Address - Phone:904-269-7200
Mailing Address - Fax:904-269-0070
Practice Address - Street 1:1409 KINGSLEY AVE STE 8
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4553
Practice Address - Country:US
Practice Address - Phone:904-269-7200
Practice Address - Fax:904-269-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1005022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty