Active NPI
Jacqueline McIntosh
- Mental Health Counselor
- Fort Lauderdale, FL
National Provider Identifier
1740668219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH24666
- Practice address
- 1445 W Broward Blvd
Fort Lauderdale, FL 33312-1504 - Phone
- (954) 712-2530
- NPI assigned
- May 15, 2015
- Sex
- Female
- Sole proprietor
- No
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 | MH24666 | FL | Primary |
Addresses
Primary practice location
1445 W Broward Blvd
Fort Lauderdale, FL 33312-1504
Mailing address
2833 NW 91St Ave Apt 104
Coral Springs, FL 33065-5066
Phone (954) 856-0054
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 |
|---|---|---|---|
| MH24666 | FL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ruach Renewal Therapy Center PLLC | Mental Health | Current | 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.
-
- Mental Health Counselor
- Coral Springs, FL
- NPI 1588531370
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1431648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733270400000",
"number": "1740668219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2833 NW 91ST AVE APT 104",
"city": "CORAL SPRINGS",
"state": "FL",
"postal_code": "330655066",
"telephone_number": "954-856-0054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1445 W BROWARD BLVD",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333121504",
"telephone_number": "954-712-2530"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCINTOSH",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-05-15",
"last_updated": "2024-12-04",
"certification_date": "2024-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH24666",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lauderdale, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.