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Organization
HYATT HAVEN MENTAL HEALTH CLINIC
Active
Organization
HYATT HAVEN MENTAL HEALTH CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACQUELYN HYATT PHARMD (OWNER/MANAGER)
(904) 742-8623
Entity
Organization
Contact information
Practice address
2140 KINGSLEY AVE STE 8, ORANGE PARK, FL 32073-5129
(904) 742-8623
Mailing address
630 PLAINFIELD AVE, ORANGE PARK, FL 32073-2916
(904) 742-8623
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
NULL
101Y00000X
Counselor
—
—
103T00000X
Psychologist
—
NULL
103T00000X
Psychologist
—
—
163W00000X
Registered Nurse
—
NULL
163W00000X
Registered Nurse
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
12/09/2024
Last updated
12/09/2024
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