Individual provider Active NPI

Nicole Marie De la Torre Salas, LMHC

  • Mental Health Counselor
  • Jacksonville, FL
National Provider Identifier
1710484258
Registry record updated May 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH23301 Issued in FL
Practice address
4595 Lexington Ave FL 32210
Jacksonville, FL 32210-2058
Phone
(904) 448-4700
NPI assigned
Apr 11, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2026

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 MH23301 FL Primary

Addresses

Primary practice location

4595 Lexington Ave FL 32210
Jacksonville, FL 32210-2058

Mailing address

1532 Kingsley Ave Ste 112-114
Orange Park, FL 32073-4538
Phone (904) 214-3222

Other practice location 1

1532 Kingsley Ave Ste 112-114
Orange Park, FL 32073-4538
Phone (904) 214-3222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260605000076 FL Practitioner - Mental Health Counselor 3375014855 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2015
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4310 Metro Pkwy
Fort Myers, FL 33916-7952

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MH23301FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Child Guidance Center, Inc. CurrentSince Sep 5, 2021 Accepting new patients

Locations

4595 Lexington Ave
Jacksonville, FL 32210
Phone (904) 488-4700

Organizations & group practices 2

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": "1523404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779321600000",
    "number": "1710484258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1532 KINGSLEY AVE STE 112-114",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734538",
            "telephone_number": "904-214-3222",
            "fax_number": "904-375-8625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4595 LEXINGTON AVE FL 32210",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322102058",
            "telephone_number": "904-448-4700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1532 Kingsley Ave Ste 112-114",
            "address_purpose": "LOCATION",
            "city": "Orange Park",
            "state": "FL",
            "postal_code": "320734538",
            "country_code": "US",
            "telephone_number": "904-214-3222",
            "fax_number": "904-375-8625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE LA TORRE SALAS",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "name_prefix": "Miss",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-11",
        "last_updated": "2026-05-21",
        "certification_date": "2026-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH23301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.