NPI 1326436981 · live from the CMS NPI Registry
Justin Tyler Bollingmo, LMFT
Marriage & Family Therapist in Jacksonville, FL. National Provider Identifier 1326436981, active.
NPI record
| NPI | 1326436981 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Marriage & Family Therapist 106H00000X |
| Practice location | 1650 Prudential Dr Ste 210, Jacksonville, FL 32207 |
| Practice phone | 904-376-3800 |
| Mailing address | Po Box 748519, Atlanta, GA 30374 |
| Enumerated | January 6, 2015 |
| Last updated | May 13, 2022 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Marriage & Family Therapist primary | 106H00000X | 3292 (FL) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.