| James Derisse, | |
|
2700 University Blvd W Bldg B, Jacksonville, FL 32217-2147 | |
| (904) 638-9767 | |
| Not Available |
| Full Name | James Derisse |
|---|---|
| Gender | Male |
| Speciality | Counselor - Mental Health |
| Location | 2700 University Blvd W Bldg B, Jacksonville, Florida |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780295170 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 84360 (Texas) | Secondary |
| 101YM0800X | Counselor - Mental Health | 22327 (Florida) | Primary |
| Entity Name | Grow Healthcare Group PA |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1245845932 PECOS PAC ID: 3476961368 Enrollment ID: O20210414000053 |
| Mailing Address | Practice Location Address |
|---|---|
| James Derisse, 159 Silver Creek Pl, Saint Augustine, FL 32095-9003 Ph: (904) 386-4253 | James Derisse, 2700 University Blvd W Bldg B, Jacksonville, FL 32217-2147 Ph: (904) 638-9767 |
Mrs. Gloria Hanania, LMHC Counselor Medicare: Medicare Enrolled Practice Location: 390 Park St, Jacksonville, FL 32204 Phone: 904-899-6300 |
Yvette Culver-owens, LMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 6817 Southpoint Pkwy, Suite 1304, Jacksonville, FL 32216 Phone: 904-505-3983 Fax: 904-725-9833 |
Dawn S. Liphart, LMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 11265 Alumni Way, Jacksonville, FL 32246 Phone: 904-398-2020 Fax: 904-724-2172 |
Stanvonna Shootes, Counselor Medicare: Not Enrolled in Medicare Practice Location: 435 Clark Rd, Suite 107, Jacksonville, FL 32218 Phone: 904-765-0665 Fax: 904-765-0664 |
Mrs. Amanda Sweat, L.M.H.C Counselor Medicare: Not Enrolled in Medicare Practice Location: 8465 Merchants Way Ste 206, Jacksonville, FL 32222 Phone: 423-206-2299 Fax: 423-717-5594 |
Stephanie Cheryl Bosh, MS, MCAP Counselor Medicare: Not Enrolled in Medicare Practice Location: 580 Ellis Rd S, Jacksonville, FL 32254 Phone: 904-423-0017 |
Sergio Perez, Counselor Medicare: Not Enrolled in Medicare Practice Location: 4595 Lexington Ave, Jacksonville, FL 32210 Phone: 904-448-4700 |