Provider Demographics
NPI:1871909226
Name:PUZZLE PEACE COUNSELING, LLC
Entity type:Organization
Organization Name:PUZZLE PEACE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERSKOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:904-501-3809
Mailing Address - Street 1:5270 PALM VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3200
Mailing Address - Country:US
Mailing Address - Phone:904-501-3809
Mailing Address - Fax:
Practice Address - Street 1:5270 PALM VALLEY RD
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32082-3200
Practice Address - Country:US
Practice Address - Phone:904-501-3809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12319101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty