River City Mental Health Counseling, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

RIVER CITY MENTAL HEALTH COUNSELING, LLC

Practice address

4711 US Highway 17 Ste 4
Fleming Island, FL 32003-8211

Phone

(904) 465-1275

Fax

(904) 485-8359

NPI assigned

Aug 15, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Michael Brent Wade Jr., LMHCNPI 1639483688

Title

Owner

Phone

(904) 465-1275

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Michael Brent Wade Jr., LMHC

  • Professional Counselor
  • Fleming Island, FL
  • NPI 1639483688
  NPD Authorized official

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

{
    "created_epoch": "1565827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565827200000",
    "number": "1518513506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 MARISCO WAY",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322204608",
            "telephone_number": "904-465-1275",
            "fax_number": "904-485-8359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4711 US HIGHWAY 17 STE 4",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320038211",
            "telephone_number": "904-465-1275",
            "fax_number": "904-485-8359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER CITY MENTAL HEALTH COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-15",
        "last_updated": "2019-08-15",
        "status": "A",
        "authorized_official_last_name": "WADE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "BRENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-465-1275",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007650300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard D Curtis M.D., P.a.
• Lindsay Richmond, APRN
• Luis Ernesto Rios Jr., M.D., M.P.H.
• Rise & Flourish ABA Therapy, LLC
• Rise & Flourish ABA Therapy, LLC
• Riverside Spine & Pain Physicians, LLC
• Coralynn T Roberts, OT
• Samuel Robertson
• Nathan Francis Antonio Robinson
• Marilyn Margarita Rodriguez Ballard, APRN

• Mental Health Clinic/Center (Including Community Mental Health Center) in Fleming Island, FL
• Providers in Fleming Island, FL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; 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.