Active NPI
Amanda Maria Larson
- Mental Health Counselor
- Middleburg, FL
National Provider Identifier
1114568912
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH17383
- Practice address
- 3292 County Road 220
Middleburg, FL 32068-4357 - Phone
- (904) 291-5561
- Fax
- (904) 291-5575
- NPI assigned
- Oct 2, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MH17383 | FL | Primary |
Addresses
Primary practice location
3292 County Road 220
Middleburg, FL 32068-4357
Mailing address
1726 Kingsley Ave Ste 2
Orange Park, FL 32073-4411
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH17383 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578268800000",
"number": "1114568912",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1726 KINGSLEY AVE STE 2",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320734411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3292 COUNTY ROAD 220",
"city": "MIDDLEBURG",
"state": "FL",
"postal_code": "320684357",
"telephone_number": "904-291-5561",
"fax_number": "904-291-5575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "AMANDA",
"middle_name": "MARIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-02",
"last_updated": "2020-01-06",
"certification_date": "2020-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH17383",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middleburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.