Active NPI
Jacqueline Jonas McCollum, LMHC
- Mental Health Counselor
- Leesburg, FL
National Provider Identifier
1689875122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH 5473
- Practice address
- 217 N 14TH St
Leesburg, FL 34748-4821 - Phone
- (352) 365-1098
- Fax
- (352) 365-2334
- NPI assigned
- May 31, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MH 5473 | FL | Primary |
Addresses
Primary practice location
217 N 14TH St
Leesburg, FL 34748-4821
Mailing address
1318 Springlake Rd
Fruitland Park, FL 34731
Phone (352) 728-8539
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Z9825 | Other | FL | BCBS NUMBER |
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
| License | State | Type | Specialty |
|---|---|---|---|
| MH 5473 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689875122",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1318 SPRINGLAKE RD",
"city": "FRUITLAND PARK",
"state": "FL",
"postal_code": "34731",
"telephone_number": "352-728-8539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "217 N 14TH ST",
"city": "LEESBURG",
"state": "FL",
"postal_code": "347484821",
"telephone_number": "352-365-1098",
"fax_number": "352-365-2334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCOLLUM",
"first_name": "JACQUELINE",
"middle_name": "JONAS",
"name_prefix": "Mrs.",
"credential": "LMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH 5473",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NUMBER",
"identifier": "Z9825",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Leesburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.