NPIMap

Organization Active NPI

Provenzano Counseling Services

  • Counselor
  • Jacksonville, FL
National Provider Identifier
1487167227
Registry record updated Nov 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
MH9038 Issued in FL
Legal business name
PROVENZANO COUNSELING SERVICES
Practice address
13400 Sutton Park Dr S Ste 1504
Jacksonville, FL 32224-0237
Phone
(904) 568-5826
NPI assigned
Nov 15, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2017

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

Authorized official

Name
Mrs. Liza Cristin Provenzano, LMHCNPI 1427203736
Title
Owner/Counselor
Phone
(904) 568-5826

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101Y00000X MH9038 FL Primary

Addresses

Primary practice location

13400 Sutton Park Dr S Ste 1504
Jacksonville, FL 32224-0237

Mailing address

912 Collinswood Dr W
Jacksonville, FL 32225-0861
Phone (904) 568-5826

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1510704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510704000000",
    "number": "1487167227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 COLLINSWOOD DR W",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322250861",
            "telephone_number": "904-568-5826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13400 SUTTON PARK DR S STE 1504",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322240237",
            "telephone_number": "904-568-5826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVENZANO COUNSELING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-15",
        "last_updated": "2017-11-15",
        "status": "A",
        "authorized_official_last_name": "PROVENZANO",
        "authorized_official_first_name": "LIZA",
        "authorized_official_middle_name": "CRISTIN",
        "authorized_official_title_or_position": "OWNER/COUNSELOR",
        "authorized_official_telephone_number": "904-568-5826",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor",
            "state": "FL",
            "license": "MH9038",
            "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 Nov 15, 2017; 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.