PSI SERVICES III, INC. (NPI# 1013113554) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013113554 |
| Entity Type | Organization |
| Organization Name | PSI SERVICES III, INC. |
| Practice Address |
3890 Dunn Ave Suite 1104 Jacksonville FL 32218-6428 |
| Practice Telephone | 9047236049 |
| Practice Fax Number | 9047235094 |
| Mailing Telephone | 9047236049 |
| Mailing Fax Number | 9047235094 |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2008-08-19 |
| Authorized Official Name | RICKY WALLACE (CEO) |
| Authorized Official Telephone | 9047236049 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251C00000X | Day Training, Developmentally Disabled Services | F=========001 | FL | Agencies |
| Y | 251S00000X | Community/Behavioral Health | FL | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 76505 1500 | 05 | |
| FL | 686933596 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942578133 | Psi Services IIi, Inc. | Clinic/Center | 770 M Street Se, Washington, DC 20003-3609 | 2011-12-02 |
| 1952452096 | Psi Services IIi, Inc. | Clinic/Center | 4819 Soutel Dr, Jacksonville, FL 32208-1856 | 2007-01-16 |
| 1114399862 | Psi Services IIi, Inc. | Clinic/Center | 5820 Dix St Ne, Washington, DC 20019-6965 | 2015-10-21 |
| 1306149844 | Psi Services IIi, Inc. | Clinic/Center | 3890 Dunn Ave, Suite 1104, Jacksonville, FL 32218-6428 | 2010-12-06 |
| 1366653487 | Psi Services IIi, Inc. | Clinic/Center | 770 M St Se, Washington, DC 20003-3609 | 2007-05-24 |
| Street Address |
3890 DUNN AVE SUITE 1104 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32218-6428 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174595318 | Tina Nannette Tillis | Ophthalmology | 3890 Dunn Ave, #902, Jacksonville, FL 32218-6428 | 2006-02-02 |
| 1083155725 | First Coast Cardiovascular | Internal Medicine | 3890 Dunn Ave, Ste 203, Jacksonville, FL 32218-6428 | 2017-03-14 |
| 1740631738 | Terra Harold Jackson | Social Worker | 3890 Dunn Ave, Suite 1104, Jacksonville, FL 32218-6428 | 2016-06-30 |
| 1467867168 | Tntmd Pa | Ophthalmology | 3890 Dunn Ave, Suite 902, Jacksonville, FL 32218-6428 | 2014-06-23 |
| 1639507254 | John Warren | Counselor | 3890 Dunn Ave, Jacksonville, FL 32218-6428 | 2013-10-16 |
| 1063847465 | Psi Behavioral Health LLC | Case Management | 3890 Dunn Ave, Suite 1104, Jacksonville, FL 32218-6428 | 2013-09-05 |
| 1124460738 | Psi Family Services | Community/Behavioral Health | 3890 Dunn Ave, Suite 1104, Jacksonville, FL 32218 | 2013-07-24 |
| 1154762284 | Psi Behavioral Health, LLC | Clinic/Center | 3890 Dunn Ave, Sutie 1104, Jacksonville, FL 32218-6428 | 2013-07-17 |
| 1326394792 | Veronica Thompson | Social Worker | 3890 Dunn Ave, Ste. 1104, Jacksonville, FL 32218-6428 | 2012-08-03 |
| 1922361732 | Psi Family Services, Inc. | Preferred Provider Organization | 3890 Dunn Ave, 1104, Jacksonville, FL 32218-6428 | 2012-06-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629684170 | Damon Lamar Baker | Nurse Practitioner | 12533 Sampson Rd, Jacksonville, Fl, FL 32218 | 2020-09-21 |
| 1578199303 | First Coast Health Ventures, LLC | Skilled Nursing Facility | 15480 Max Leggett Parkway, Jacksonville, FL 32218 | 2020-03-12 |
| 1932679594 | Alaina Rachelle Stanley | Counselor | 11683 Spring Board Dr, Jacksonville, FL 32218 | 2018-11-27 |
| 1508345133 | War Cry Ministry Inc | Counselor | 435 Eric Ave, Jacksonville, FL 32218 | 2018-08-14 |
| 1285111484 | St Vincent's Full Service Urgent Care, LLC | Clinic/Center | 15510 Max Leggett Parkway, Ste A, Jacksonville, FL 32218 | 2018-07-20 |
| 1427544501 | Derrick Roberts | Behavioral Analyst | 11302 Forestdale Rd, Jacksonville, FL 32218 | 2018-07-02 |
| 1215420229 | Companion & Compassion LLC | Home Health | 856 Poydras Ln W, Jacksonville, FL 32218 | 2018-06-13 |
| 1952894784 | Michael Alexander Aaro | Dentist | 1840 Dunn Ave Ste 3, Jacksonville, FL 32218 | 2018-06-06 |
| 1235629445 | Melissa C Moree | Counselor | 13453 Main St. North, Suite 104, Jacksonville, FL 32218 | 2018-05-14 |
| 1861900896 | Sheila Nowlin | Physical Therapist | 1034 Dunn Ave, Jacksonville, FL 32218 | 2018-01-11 |
| Find all providers in zip 32218 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104427632 | Sunzup Counseling and Wellness | Community/Behavioral Health | 3355 Claire Ln Apt 1116, Jacksonville, FL 32223-6662 | 2020-11-02 |
| 1063043420 | Elephant Clinic Ltd. | Community/Behavioral Health | 8 Unf Dr # 221, Jacksonville, FL 32224-7699 | 2020-02-03 |
| 1679056857 | Inspire To Rise Inc. | Community/Behavioral Health | 4603 Silverthorn Dr, Jacksonville, FL 32258-2010 | 2018-09-13 |
| 1558863787 | Positive Development, LLC | Community/Behavioral Health | 3840 Belfort Rd Ste 302, Jacksonville, FL 32216-8210 | 2018-03-04 |
| 1073012555 | Pivotal Step Services, Pllc | Community/Behavioral Health | 1106b Gum Branch Rd, Jacksonville, NC 28540-5743 | 2018-02-09 |
| 1518473594 | Werp LLC | Community/Behavioral Health | 5291 Collins Rd Lot 293, Jacksonville, FL 32244-5389 | 2017-12-28 |
| 1871007062 | National Youth Advocate Program, Inc | Community/Behavioral Health | 2200 Rosselle St, Jacksonville, FL 32204-3126 | 2017-11-27 |
| 1962913327 | Port Health Services | Community/Behavioral Health | 224 Memorial Dr Ste B, Jacksonville, NC 28546-6332 | 2017-10-12 |
| 1598282667 | B.e.h. Elderly Care LLC | Community/Behavioral Health | 5145 Timuquana Rd Apt 6, Jacksonville, FL 32210-8923 | 2017-08-29 |
| 1427598689 | Family Farms of Northeast Florida | Community/Behavioral Health | 16844 Ethel Rd, Jacksonville, FL 32218-1108 | 2017-03-06 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32218 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.