Tia Wilson, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH12025 Issued in FL

Practice address

1726 Kingsley Ave
Orange Park, FL 32073

Phone

(904) 278-5659

NPI assigned

Aug 6, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Daniel Memorial, Inc.

  • Community/Behavioral Health Agency
  • Jacksonville, FL
  • NPI 1346205861
  NPD (past)

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

{
    "created_epoch": "1375747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530230400000",
    "number": "1245662832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "552 RYKER WAY",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320658218",
            "telephone_number": "904-887-1121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1726 KINGSLEY AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "32073",
            "telephone_number": "904-278-5659"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4203 Southpoint Blvd",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322166164",
            "country_code": "US",
            "telephone_number": "904-296-1055 x1029",
            "fax_number": "904-296-1953",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3292 County Road 220",
            "address_purpose": "LOCATION",
            "city": "Middleburg",
            "state": "FL",
            "postal_code": "320684357",
            "country_code": "US",
            "telephone_number": "904-887-1121",
            "fax_number": "904-291-5575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "TIA",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-08-06",
        "last_updated": "2018-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "IMH6626",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH12025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Assumpta Wilson
• Kayla Madisen Wilson
• Kristine Elizabeth Wilson, CRNA, DNP, ARNP
• Kristopher Edward Wilson, MOT
• Robert Anthony Wilson II, PHARMD
• Windows of Hope Inc.
• Jennifer Adams Winston, D.P.T.
• Katherine Wise, MA, LMHC
• Nicole Juline Wissel, APRN
• Anne H Witt, ARNP

• Mental Health Counselor in Orange Park, FL
• Providers in Orange Park, 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 Jun 29, 2018; 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.