Provider Demographics
NPI:1174389951
Name:JVL MENTAL HEALTH CONSULT
Entity type:Organization
Organization Name:JVL MENTAL HEALTH CONSULT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN-LARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-831-0223
Mailing Address - Street 1:321 ROCKAWAY PKWY
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-3447
Mailing Address - Country:US
Mailing Address - Phone:631-831-0223
Mailing Address - Fax:
Practice Address - Street 1:321 ROCKAWAY PKWY
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-3447
Practice Address - Country:US
Practice Address - Phone:631-831-0223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center