NPIMap

Organization Active NPI

Theralogy, LLC

  • Professional Counselor
  • Jacksonville Beach, FL
National Provider Identifier
1154918209
Registry record updated Dec 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
THERALOGY, LLC
Practice address
4300 Marsh Landing Blvd
Suite 204
Jacksonville Beach, FL 32250
Phone
(904) 515-2050
NPI assigned
Dec 23, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2020

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

Authorized official

Name
Christine Ellis, LMHCNPI 1205216314
Title
MGR
Phone
(904) 515-2370

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

4300 Marsh Landing Blvd
Suite 204
Jacksonville Beach, FL 32250

Mailing address

1015 Atlantic Blvd Ste 161
Atlantic Beach, FL 32233-3313
Phone (904) 515-2370

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1608681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608681600000",
    "number": "1154918209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 ATLANTIC BLVD STE 161",
            "city": "ATLANTIC BEACH",
            "state": "FL",
            "postal_code": "322333313",
            "telephone_number": "904-515-2370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 MARSH LANDING BLVD",
            "address_2": "SUITE 204",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "32250",
            "telephone_number": "904-515-2050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERALOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-23",
        "last_updated": "2020-12-23",
        "certification_date": "2020-12-14",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "MGR",
        "authorized_official_telephone_number": "904-515-2370",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 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.

Verify at the official NPI Registry.