Active NPI
Ida Marie Holley, LMHC
- Mental Health Counselor
- Orange Park, FL
National Provider Identifier
1316084494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH6257
- Practice address
- 1532 Kingsley Ave
Suite 112
Orange Park, FL 32073-4538 - Phone
- (904) 278-8722
- Fax
- (904) 278-4880
- NPI assigned
- Jan 30, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- 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 | MH6257 | FL | Primary |
Addresses
Primary practice location
1532 Kingsley Ave
Suite 112
Orange Park, FL 32073-4538
Mailing address
PO Box 1457
Orange Park, FL 32067-1457
Phone (904) 278-8722
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 |
|---|---|---|---|
| MH6257 | FL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Professional Christian Counseling | Mental Health | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316084494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1457",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320671457",
"telephone_number": "904-278-8722",
"fax_number": "904-278-4880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1532 KINGSLEY AVE",
"address_2": "SUITE 112",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320734538",
"telephone_number": "904-278-8722",
"fax_number": "904-278-4880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLEY",
"first_name": "IDA",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "LMHC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH6257",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.