Individual provider Active NPI

Jerica Michele McQueen, LMHC

  • Mental Health Counselor
  • St Augustine, FL
National Provider Identifier
1194527895
Registry record updated Mar 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH25402 Issued in FL
Practice address
7985 Colee Cove Rd
St Augustine, FL 32092-2306
Phone
(904) 322-1816
NPI assigned
Mar 25, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X MH25402 FL Primary

Addresses

Primary practice location

7985 Colee Cove Rd
St Augustine, FL 32092-2306

Mailing address

7985 Colee Cove Rd
St Augustine, FL 32092-2306
Phone (904) 322-1816

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250429003692 FL Practitioner - Mental Health Counselor 1052837333 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Mental Health CurrentSince Mar 25, 2025 Accepting new patients

Locations

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1742860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742860800000",
    "number": "1194527895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7985 COLEE COVE RD",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320922306",
            "telephone_number": "904-322-1816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7985 COLEE COVE RD",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320922306",
            "telephone_number": "904-322-1816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCQUEEN",
        "first_name": "JERICA",
        "middle_name": "MICHELE",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-25",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH25402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

Verify at the official NPI Registry.