# PSI BEHAVIORAL HEALTH LLC

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

## Provider details

- **NPI number:** 1063847465
- **Authorized official:** MR. RICKY WALLACE (CEO)
- **Authorized official phone:** (904) 723-6049

## Contact information

- **Practice address:** 3890 DUNN AVE, SUITE 1104, JACKSONVILLE, FL 32218-6428
- **Practice address phone:** (904) 723-6049
- **Mailing address:** 3890 DUNN AVE, SUITE 1104, JACKSONVILLE, FL 32218-6428
- **Mailing address phone:** (904) 723-6049

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 09/05/2013
- **Last updated:** 09/05/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | PENDING | — | FL |