Organization
MTB THERAPIST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MERLAND BAKER LMHC (DIRECTOR)
(904) 322-2162
Entity
Organization
Contact information
Practice address
6034 CHESTER AVE, JACKSONVILLE, FL 32217-2264
(904) 323-2019
Mailing address
3452 LIVE OAK HOLLOW DR, ORANGE PARK, FL 32065-2525
(904) 323-0469
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
15468
FL
101YA0400X
Addiction (Substance Use Disorder) Counselor
15468
FL
101YM0800X
Mental Health Counselor
15468
FL
101YP2500X
Professional Counselor
Primary
15468
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MH15468
261QM0801X - CLINIC/CENTER - MENTAL HEALTH (INCLUDING COMMUNITY MENTAL HEALTH CE
FL
Enumeration date
01/27/2018
Last updated
04/22/2025
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