Active NPI
Jack Mathew Davis, IMH
- Mental Health Counselor
- Jacksonville, FL
National Provider Identifier
1255197356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- IMH24995
- Practice address
- 820 Prudential Dr Ste 510
Jacksonville, FL 32207-8207 - Phone
- (904) 376-3800
- Fax
- (904) 390-7398
- NPI assigned
- Feb 26, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | IMH24995 | FL | Primary |
Addresses
Primary practice location
820 Prudential Dr Ste 510
Jacksonville, FL 32207-8207
Mailing address
PO Box 748519
Atlanta, GA 30374-8519
Phone (904) 376-3800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IMH24995 | FL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Baptist Behavioral Health, LLC | Mental Health | Current | Accepting new patients |
| Montesinos Counseling Services, LLC | Mental Health | Past | Accepting new patients |
Locations
820 Prudential Dr
Ste 510
Jacksonville, FL 32207
Organizations & group practices 2
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.
-
- Mental Health Counselor
- Jacksonville, FL
- NPI 1972377539
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708905600000",
"number": "1255197356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 748519",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303748519",
"telephone_number": "904-376-3800",
"fax_number": "904-376-3998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 PRUDENTIAL DR STE 510",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322078207",
"telephone_number": "904-376-3800",
"fax_number": "904-390-7398"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "JACK",
"middle_name": "MATHEW",
"credential": "IMH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-02-26",
"last_updated": "2024-02-26",
"certification_date": "2024-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "IMH24995",
"primary": true
}
],
"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 Feb 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.