Individual provider Active NPI

Amanda Brooks Decker, MA, RMHCI

  • Mental Health Counselor
  • Jacksonville, FL
National Provider Identifier
1417763988
Registry record updated Dec 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
IMH26069 Issued in FL
Practice address
6817 Southpoint Pkwy Ste 2503
Jacksonville, FL 32216-8200
Phone
(904) 326-0246
NPI assigned
Dec 9, 2024
Last updated
Dec 9, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 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 IMH26069 FL Primary

Addresses

Primary practice location

6817 Southpoint Pkwy Ste 2503
Jacksonville, FL 32216-8200

Mailing address

6817 Southpoint Pkwy Ste 2503
Jacksonville, FL 32216-8200
Phone (904) 326-0246

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
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
IMH26069FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Coleman Counseling, PLLC Mental Health CurrentSince Dec 15, 2024 Accepting new patients

Locations

6817 Southpoint Pkwy
Ste 2503
Jacksonville, FL 32216
Phone (904) 326-0246

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": "1733702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1417763988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6817 SOUTHPOINT PKWY STE 2503",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168200",
            "telephone_number": "904-326-0246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6817 SOUTHPOINT PKWY STE 2503",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168200",
            "telephone_number": "904-326-0246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECKER",
        "first_name": "AMANDA",
        "middle_name": "BROOKS",
        "credential": "MA, RMHCI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-09",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "IMH26069",
            "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 Dec 9, 2024; 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.