Individual
KACEY YOUROUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6867 SOUTHPOINT DR N, JACKSONVILLE, FL 32216-8043
(904) 619-6071
Mailing address
12301 KERNAN FOREST BLVD, 302, JACKSONVILLE, FL 32225-5597
(270) 300-8561
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
45 CFR 160.103
FL
Other
Enumeration date
10/12/2015
Last updated
10/12/2015
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