Individual provider Active NPI

Lisa Michelle Branham, LMHC

  • Mental Health Counselor
  • Jacksonville, FL
National Provider Identifier
1619002409
Registry record updated Oct 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH10872 Issued in FL
Practice address
9995 Gate Pkwy N Ste 100
Jacksonville, FL 32246-0800
Phone
(833) 769-3524
NPI assigned
Feb 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2025

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 MH10872 FL Primary

Addresses

Primary practice location

9995 Gate Pkwy N Ste 100
Jacksonville, FL 32246-0800

Mailing address

9995 Gate Pkwy N Ste 100
Jacksonville, FL 32246-0800
Phone (833) 769-3524

Other practice location 1

6316 San Juan Ave
Jacksonville, FL 32210-2831
Phone (904) 783-2579 ext. 30

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

State licenses

LicenseStateTypeSpecialty
MH10872FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Personal Recovery Network LLC CurrentSince Nov 7, 2025 Accepting new patients

Locations

9995 Gate Pkwy N
Ste 100
Jacksonville, FL 32246
Phone (904) 981-1616

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761264000000",
    "number": "1619002409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9995 GATE PKWY N STE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322460800",
            "telephone_number": "833-769-3524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9995 GATE PKWY N STE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322460800",
            "telephone_number": "833-769-3524"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6316 San Juan Ave",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322102831",
            "country_code": "US",
            "telephone_number": "904-783-2579 x30",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRANHAM",
        "first_name": "LISA",
        "middle_name": "MICHELLE",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-22",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH10872",
            "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 Oct 24, 2025; 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.