# HYATT HAVEN MENTAL HEALTH CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063228559
- **Authorized official:** DR. JACQUELYN HYATT PHARMD (OWNER/MANAGER)
- **Authorized official phone:** (904) 742-8623

## Contact information

- **Practice address:** 2140 KINGSLEY AVE STE 8, ORANGE PARK, FL 32073-5129
- **Practice address phone:** (904) 742-8623
- **Mailing address:** 630 PLAINFIELD AVE, ORANGE PARK, FL 32073-2916
- **Mailing address phone:** (904) 742-8623

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 12/09/2024
- **Last updated:** 12/09/2024