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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
103T00000X
Psychologist
163W00000X
Registered Nurse
2084P0800X
Psychiatry Physician
261QM1300X
Multi-Specialty Clinic/Center
Primary
363LP0808X
Psychiatric/Mental Health Nurse Practitioner

Other

Enumeration date
12/09/2024
Last updated
12/09/2024
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