Organization Active NPI

Biofeedback Associates of NE FL

  • Mental Health Counselor
  • Jacksonville, FL
National Provider Identifier
1235152604
Registry record updated Jan 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH6843 Issued in FL
Legal business name
BIOFEEDBACK ASSOCIATES OF NE FL
Practice address
11512 Lake Mead Ave
Suite 703
Jacksonville, FL 32256
Phone
(904) 646-0054
Fax
(904) 646-0930
NPI assigned
Jul 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2019

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

Authorized official

Name
Annette Marie Tharp-Wright, MS, LMHC, NCC
Title
Owner/ Counselor
Phone
(904) 646-0054

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X MH2969 FL
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X MH6843 FL Primary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X MH5155 FL
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X MH5132 FL
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X MH4616 FL
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X SW2527 FL
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X SW1447 FL
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X

Addresses

Primary practice location

11512 Lake Mead Ave
Suite 703
Jacksonville, FL 32256

Mailing address

11512 Lake Mead Ave
Suite 703
Jacksonville, FL 32256
Phone (904) 646-0054

National Provider Directory

National Provider Directory

Locations

11512 Lake Mead Ave
Unit 703
Jacksonville, FL 32256
Phone (904) 646-0051

Practitioners & affiliated clinicians

Practitioners 5

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": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548633600000",
    "number": "1235152604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11512 LAKE MEAD AVE",
            "address_2": "SUITE 703",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32256",
            "telephone_number": "904-646-0054",
            "fax_number": "904-646-0930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11512 LAKE MEAD AVE",
            "address_2": "SUITE 703",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32256",
            "telephone_number": "904-646-0054",
            "fax_number": "904-646-0930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIOFEEDBACK ASSOCIATES OF NE FL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2019-01-28",
        "status": "A",
        "authorized_official_last_name": "THARP-WRIGHT",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER/ COUNSELOR",
        "authorized_official_telephone_number": "904-646-0054",
        "authorized_official_credential": "MS, LMHC, NCC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH2969",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH6843",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH5155",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH5132",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH4616",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "SW2527",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "SW1447",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Jan 28, 2019; 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.