Ethereal Counseling Center LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

ETHEREAL COUNSELING CENTER LLC

Practice address

10035 Bengal Fox Dr
Jacksonville, FL 32222-2895

Phone

(904) 515-3326

NPI assigned

Nov 10, 2021

Organization subpart

No

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

Authorized official

Name

Dana Weiss

Title

Credentialing Specialist

Phone

(904) 701-3076

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 1

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

• Yolla N Baddour, LMHC

  • Mental Health Counselor
  • Jacksonville, FL
  • NPI 1770051419
  Medicare reassignment NPD

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

{
    "created_epoch": "1636502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690156800000",
    "number": "1164188496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10035 BENGAL FOX DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322222895",
            "telephone_number": "904-515-3326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10035 BENGAL FOX DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322222895",
            "telephone_number": "904-515-3326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHEREAL COUNSELING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-10",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A",
        "authorized_official_last_name": "WEISS",
        "authorized_official_first_name": "DANA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "904-701-3076"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Isabella Enid Estrada, MD, MS
• Jose Luis Estrada Jr., CRNA
• Katherine Alexandra Estrada, LPTA
• Miguel A Estrada, OD
• Eternity Helping Hand Inc
• Louisa Etheredge, M.ED. IN COUN. ED.
• Makayla J Etheridge
• Michelle G Etheridge
• Shannon Ethridge
• Altagrace Etienne, HOME HEALTH AIDE

• Mental Health Counselor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.