Provider Demographics
NPI:1720895931
Name:MY LIFE JAX THERAPY AND COACHING
Entity type:Organization
Organization Name:MY LIFE JAX THERAPY AND COACHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHRLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFT
Authorized Official - Phone:904-694-2552
Mailing Address - Street 1:3010 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5857
Mailing Address - Country:US
Mailing Address - Phone:904-694-2552
Mailing Address - Fax:
Practice Address - Street 1:3010 3RD ST S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-5857
Practice Address - Country:US
Practice Address - Phone:904-694-2552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health