Provider Demographics
NPI:1831510304
Name:PSYCHOEDUCATIONAL CONSULTANT GROUP
Entity type:Organization
Organization Name:PSYCHOEDUCATIONAL CONSULTANT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:EDS
Authorized Official - Phone:904-874-6164
Mailing Address - Street 1:4745 SUTTON PARK CT
Mailing Address - Street 2:SUITE 802
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0250
Mailing Address - Country:US
Mailing Address - Phone:904-874-6164
Mailing Address - Fax:
Practice Address - Street 1:4745 SUTTON PARK CT
Practice Address - Street 2:SUITE 802
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-0250
Practice Address - Country:US
Practice Address - Phone:904-874-6164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS873103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty