| Positive Change Mental Health Llc | |
|
6620 Southpoint Dr S Ste 450f Jacksonville FL 32216-0912 | |
| (904) 383-7352 | |
| Not Available |
| Full Name | Positive Change Mental Health Llc |
|---|---|
| Speciality | Psychologist |
| Location | 6620 Southpoint Dr S Ste 450f, Jacksonville, Florida |
| Authorized Official Name and Position | Paul Daniel Knabb (OWNER) |
| Authorized Official Contact | 9043837352 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Positive Change Mental Health Llc 9771 Riddle Rd Jacksonville FL 32220-1919 Ph: (904) 383-7352 | Positive Change Mental Health Llc 6620 Southpoint Dr S Ste 450f Jacksonville FL 32216-0912 Ph: (904) 383-7352 |
| NPI Number | 1033462163 |
|---|---|
| Provider Enumeration Date | 10/26/2012 |
| Last Update Date | 01/08/2024 |
| Certification Date | 01/08/2024 |
| Medicare PECOS PAC ID | 7416195128 |
|---|---|
| Medicare Enrollment ID | O20130607000089 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033462163 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | PY8463 (Florida) | Primary |
| Provider Name | Paul Daniel Knabb |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528317203 PECOS PAC ID: 5092952648 Enrollment ID: I20130520000154 |
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