NPIMap

Organization Active NPI

Southern Baptist Hospital

Doing business as Psychiatric and Psychological Care

  • Mental Health Counselor
  • Orange Park, FL
National Provider Identifier
1720289507
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
SOUTHERN BAPTIST HOSPITAL
Doing business as
Psychiatric and Psychological Care
Practice address
1279 Kingsley Ave
Suite 117
Orange Park, FL 32073-4603
Phone
(904) 376-3800
Fax
(904) 733-9598
NPI assigned
May 30, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Ellen Williams, PHDNPI 1245242049
Title
Director
Phone
(904) 376-3800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X FL Primary

Addresses

Primary practice location

1279 Kingsley Ave
Suite 117
Orange Park, FL 32073-4603

Mailing address

4160 University Blvd S
Jacksonville, FL 32216-4317
Phone (904) 376-3800

Other names 1

  • Psychiatric and Psychological Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Larry Birch18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720289507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4160 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164317",
            "telephone_number": "904-376-3800",
            "fax_number": "904-733-9598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1279 KINGSLEY AVE",
            "address_2": "SUITE 117",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734603",
            "telephone_number": "904-376-3800",
            "fax_number": "904-733-9598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN BAPTIST HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "904-376-3800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Psychiatric and Psychological Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orange Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.