NPIMap

Organization Active NPI

River's Edge Counseling, PLLC

  • Mental Health Counselor
  • Jacksonville, FL
National Provider Identifier
1053981852
Registry record updated Jun 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
RIVER'S EDGE COUNSELING, PLLC
Practice address
8465 Merchants Way Ste 104
Jacksonville, FL 32222-2858
Phone
(904) 379-8675
NPI assigned
Jun 25, 2021
Organization subpart
Yes
Parent organization
RIVERS EDGE COUNSELING PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 25, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amanda HannahNPI 1891116968
Title
Owner
Phone
(904) 379-8675

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X

Addresses

Primary practice location

8465 Merchants Way Ste 104
Jacksonville, FL 32222-2858

Mailing address

43 Knight Boxx Rd Ste 100
Orange Park, FL 32065-7395
Phone (904) 379-8675

Other identifiers 1

IdentifierTypeStateIssuer
020394200MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Rivers Edge Counseling PLLC3 organizations share this tax ID, including this one
Part of
Rivers Edge Counseling PLLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8465 Merchants Way
Ste 104
Jacksonville, FL 32222
Phone (904) 379-8675

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624579200000",
    "number": "1053981852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 KNIGHT BOXX RD STE 100",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320657395",
            "telephone_number": "904-379-8675",
            "fax_number": "904-423-0490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8465 MERCHANTS WAY STE 104",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322222858",
            "telephone_number": "904-379-8675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER'S EDGE COUNSELING, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RIVERS EDGE COUNSELING PLLC",
        "enumeration_date": "2021-06-25",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A",
        "authorized_official_last_name": "HANNAH",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-379-8675"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020394200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.