Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1205358397 |
---|---|
Provider Name | Roosevelt Bell |
First Address | Jacksonville, FL 32208-3200 |
Second Address | Jacksonville, FL 32208-3200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2017 |
Last Update Date | 17/03/2018 |