NPIMap

Organization Active NPI

Family Therapy Associates of Jacksonville LLC

  • Community/Behavioral Health Agency
  • Jacksonville, FL
National Provider Identifier
1295075190
Registry record updated Nov 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MT2673 Issued in FL
Legal business name
FAMILY THERAPY ASSOCIATES OF JACKSONVILLE LLC
Practice address
2950 Halcyon LN Ste 605
Jacksonville, FL 32223-6692
Phone
(904) 302-5340
Fax
(904) 800-1211
NPI assigned
Mar 1, 2013
Last updated
Nov 8, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2016

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

Authorized official

Name
Dr. Tabitha Johnson, PH.D., LMFTNPI 1013243542
Title
Owner/Manager
Phone
(904) 302-5340

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X MT2673 FL Primary

Addresses

Primary practice location

2950 Halcyon LN Ste 605
Jacksonville, FL 32223-6692

Mailing address

2950 Halcyon LN Ste 605
Jacksonville, FL 32223-6692
Phone (904) 302-5340

National Provider Directory

National Provider Directory

Locations

2950 Halcyon Ln
Ste 605
Jacksonville, FL 32223
Phone (904) 302-5340

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1362096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478563200000",
    "number": "1295075190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2950 HALCYON LN STE 605",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322236692",
            "telephone_number": "904-302-5340",
            "fax_number": "904-800-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2950 HALCYON LN STE 605",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322236692",
            "telephone_number": "904-302-5340",
            "fax_number": "904-800-1211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY THERAPY ASSOCIATES OF JACKSONVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-01",
        "last_updated": "2016-11-08",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TABITHA",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "904-302-5340",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D., LMFT"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "MT2673",
            "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 Nov 8, 2016; 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.