NPIMap

Organization Active NPI

Child Guidance Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jacksonville, FL
National Provider Identifier
1629646450
Registry record updated Jun 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
CHILD GUIDANCE CENTER, INC.
Practice address
1110 Edgewood Ave W
Jacksonville, FL 32208-6405
Phone
(904) 448-4700
NPI assigned
Jun 17, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2021

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

Authorized official

Name
Beth Ellen Oberlander
Title
Chief Clinical Officer
Phone
(904) 400-6739

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

1110 Edgewood Ave W
Jacksonville, FL 32208-6405

Mailing address

5776 Saint Augustine Rd
Jacksonville, FL 32207-8046
Phone (904) 400-6739

Other identifiers 1

IdentifierTypeStateIssuer
060404614MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Child Guidance Center Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

1110 Edgewood Ave W
Jacksonville, FL 32208
Phone 9044484700 ext. 601

Practitioners & affiliated clinicians

Practitioners 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1623888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623888000000",
    "number": "1629646450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5776 SAINT AUGUSTINE RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078046",
            "telephone_number": "904-400-6739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 EDGEWOOD AVE W",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322086405",
            "telephone_number": "904-448-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILD GUIDANCE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-17",
        "last_updated": "2021-06-17",
        "certification_date": "2021-06-17",
        "status": "A",
        "authorized_official_last_name": "OBERLANDER",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "CHIEF CLINICAL OFFICER",
        "authorized_official_telephone_number": "904-400-6739"
    },
    "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": "060404614",
            "state": "FL"
        }
    ],
    "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 Jun 17, 2021; 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.