Justin Tyler Bollingmo, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

3292 Issued in FL

Practice address

1650 Prudential Dr Ste 210
Jacksonville, FL 32207-8149

Phone

(904) 376-3800

Fax

(904) 396-4942

NPI assigned

Jan 6, 2015

Last updated

May 13, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Baptist Behavioral Health, LLC

  • Psychologist
  • Jacksonville, FL
  • NPI 1164155974
  NPD
• Baptist Behavioral Health, LLC

  • Professional Counselor
  • Jacksonville, FL
  • NPI 1215906649
  NPD
• Mandarin Counseling Inc

  • Clinical Social Worker
  • Jacksonville, FL
  • NPI 1811187271
  NPD (past)

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

{
    "created_epoch": "1420502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652400000000",
    "number": "1326436981",
    "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": "1650 PRUDENTIAL DR STE 210",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078149",
            "telephone_number": "904-376-3800",
            "fax_number": "904-396-4942"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "929 Peninsular Pl",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322042828",
            "country_code": "US",
            "telephone_number": "904-376-3800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLLINGMO",
        "first_name": "JUSTIN",
        "middle_name": "TYLER",
        "name_prefix": "Mr.",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-01-06",
        "last_updated": "2022-05-13",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "FL",
            "license": "3292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Lyn Bolks, M.A., CCC-SLP
• Rishitha Bollam, MD
• Valdora L Bollenback, D.P.T.
• James Bolling, MD
• Jasmine R Bolling
• Emma Boloutchi
• Bolt Behavior Services
• Kimberly J Bolton
• Mydris Boltze
• James C Boman, MD

• Marriage & Family Therapist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Marriage & Family Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2022; 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.