Provider Demographics
NPI:1316206725
Name:MY PATH MENTAL HEALTH CENTER LLC
Entity type:Organization
Organization Name:MY PATH MENTAL HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:H00
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-784-7005
Mailing Address - Street 1:822 A1A N
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3260
Mailing Address - Country:US
Mailing Address - Phone:404-784-7005
Mailing Address - Fax:
Practice Address - Street 1:822 A1A N
Practice Address - Street 2:SUITE 310
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32082-3260
Practice Address - Country:US
Practice Address - Phone:404-784-7005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health