Genesis Clinical Counseling, LLC

Key facts

NPI

1649869876

Entity type

Organization (NPI type 2)

Primary specialty

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

Legal business name

GENESIS CLINICAL COUNSELING, LLC

Practice address

2255 Dunn Ave Ste 206
Jacksonville, FL 32218-4739

Phone

(904) 201-9658

Fax

(866) 270-8565

NPI assigned

Jan 12, 2021

Organization subpart

No

Authorized official

Name

Tamara Sorrye, LMHC NPI 1598061319

Title

Owner/Therapist

Phone

(904) 219-5560

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

Practitioners 1

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

• Tamara N Sorrye Mental Health Counselor · Jacksonville, FL · NPI 1598061319
  NPD Authorized official

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 12, 2021.

{
    "created_epoch": "1610409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610409600000",
    "number": "1649869876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2255 DUNN AVE STE 206",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322184739",
            "telephone_number": "904-201-9658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 DUNN AVE STE 206",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322184739",
            "telephone_number": "904-201-9658",
            "fax_number": "866-270-8565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS CLINICAL COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-12",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A",
        "authorized_official_last_name": "SORRYE",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "904-219-5560",
        "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
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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