Provider Demographics
NPI:1861776882
Name:TEMPLE, MARGARET JO (MH 13408)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:JO
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:MH 13408
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7068 DEER LODGE CIR
Mailing Address - Street 2:UNIT 105
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8570
Mailing Address - Country:US
Mailing Address - Phone:904-450-5132
Mailing Address - Fax:
Practice Address - Street 1:1500 GANO AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4506
Practice Address - Country:US
Practice Address - Phone:904-450-5132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 13408101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional