Authentic Self Counseling of Jacksonville, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

AUTHENTIC SELF COUNSELING OF JACKSONVILLE, LLC

Practice address

7235 Bentley Rd Ste 308
Jacksonville, FL 32256-7506

Phone

(904) 990-7117

NPI assigned

Jul 28, 2019

Organization subpart

No

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

Authorized official

Name

Michelle AndersonNPI 1184192866

Title

Owner

Phone

(904) 990-7117

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Tax ID family

Authentic Self Counseling of Jacksonville LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Authentic Self Counseling of Jacksonville, LLC

  • Mental Health Counselor
  • Jacksonville, FL
  • NPI 1679460018
  NPD tax ID
• Authentic Self Counseling of Jacksonville, LLC

  • Mental Health Counselor
  • Fernandina Beach, FL
  • NPI 1982369625
  NPD tax ID

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Christine Phuong, LCSW

  • Clinical Social Worker
  • Jacksonville, FL
  • NPI 1568221091
  Medicare reassignment NPD
• Michelle Anderson, MS, LMHC

  • Mental Health Counselor
  • Jacksonville, FL
  • NPI 1184192866
  NPD (past) Authorized official
• Misti Demko, MED

  • Mental Health Counselor
  • Jacksonville, FL
  • NPI 1518655182
  NPD
• Katherine Ann Green, LMHC

  • Mental Health Counselor
  • Jacksonville, FL
  • NPI 1962863340
  NPD
• Carrie Campbell

  • Mental Health Counselor
  • Mountlake Terrace, WA
  • NPI 1811766918
  NPD
• Michael Jay Ansley, LCSW

  • Clinical Social Worker
  • Jacksonville Beach, FL
  • NPI 1760220545
  NPD (past)

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

{
    "created_epoch": "1564272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754611200000",
    "number": "1407400591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3733 UNIVERSITY BLVD W STE 203",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322172152",
            "telephone_number": "904-990-7117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7235 BENTLEY RD STE 308",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322567506",
            "telephone_number": "904-990-7117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTHENTIC SELF COUNSELING OF JACKSONVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-28",
        "last_updated": "2025-08-08",
        "certification_date": "2025-08-08",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-990-7117"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1117302000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.