Individual provider Active NPI

Jennifer Ann Coulson, MA, LMHC

  • Mental Health Counselor
  • Jacksonville, FL
National Provider Identifier
1295487791
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH23418 Issued in FL
Practice address
2392 Edgewood Ave N
Jacksonville, FL 32254-1725
Phone
(904) 781-7797
Fax
(904) 781-8685
NPI assigned
Jan 25, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

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 MH23418 FL Primary

Addresses

Primary practice location

2392 Edgewood Ave N
Jacksonville, FL 32254-1725

Mailing address

2392 Edgewood Ave N
Jacksonville, FL 32254-1725
Phone (904) 781-7797

Other practice location 1

10245 Centurion Pkwy N Ste 250
Jacksonville, FL 32256-0561
Phone (904) 674-3521

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
I20240527000057 FL Practitioner - Mental Health Counselor 4880036557 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

Practice roles

OrganizationSpecialtyStatusNew patients
Owimast Health LLC CurrentSince May 16, 2024 Accepting new patients

Locations

10245 Centurion Pkwy N
Ste 250
Jacksonville, FL 32256
Phone (904) 277-0027

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": "1643068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1295487791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2392 EDGEWOOD AVE N",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322541725",
            "telephone_number": "904-781-7797",
            "fax_number": "904-781-8685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2392 EDGEWOOD AVE N",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322541725",
            "telephone_number": "904-781-7797",
            "fax_number": "904-781-8685"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10245 Centurion Pkwy N Ste 250",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322560561",
            "country_code": "US",
            "telephone_number": "904-674-3521",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COULSON",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "credential": "MA, LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-25",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH23418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.