Active NPI
Mary Louise Prendergast, L.M.H.C.
- Mental Health Counselor
- Jacksonville, FL
National Provider Identifier
1730528381
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH 10308
- Practice address
- 836 Prudential Dr Ste 1006
Jacksonville, FL 32207-8337 - Phone
- (904) 376-3800
- Fax
- (904) 396-8966
- NPI assigned
- Jun 17, 2013
- 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 10308 | FL | Primary |
Addresses
Primary practice location
836 Prudential Dr Ste 1006
Jacksonville, FL 32207-8337
Mailing address
PO Box 748519
Atlanta, GA 30374-8519
Phone (904) 376-3800
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 10308 | FL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Baptist Behavioral Health, LLC | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
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": "1371427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700006400000",
"number": "1730528381",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 748519",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303748519",
"telephone_number": "904-376-3800",
"fax_number": "904-376-3998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "836 PRUDENTIAL DR STE 1006",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322078337",
"telephone_number": "904-376-3800",
"fax_number": "904-396-8966"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRENDERGAST",
"first_name": "MARY",
"middle_name": "LOUISE",
"credential": "L.M.H.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-06-17",
"last_updated": "2023-11-15",
"certification_date": "2023-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH 10308",
"primary": true
}
],
"identifiers": [],
"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 Nov 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.