Active NPI
Ethan Thomas
- Mental Health Counselor
- Jacksonville, FL
National Provider Identifier
1811388564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LPC5362
- Practice address
- 1900 Corporate Square Blvd
Jacksonville, FL 32216-1941 - Phone
- (904) 899-4500
- NPI assigned
- Feb 16, 2015
- Last updated
- Jun 24, 2015
- Sex
- Male
- 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 | LPC5362 | CO | Primary |
Addresses
Primary practice location
1900 Corporate Square Blvd
Jacksonville, FL 32216-1941
Mailing address
1900 Corporate Square Blvd
Jacksonville, FL 32216-1941
Phone (904) 899-4500
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 |
|---|---|---|---|
| LPC5362 | CO | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435104000000",
"number": "1811388564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 CORPORATE SQUARE BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322161941",
"telephone_number": "904-899-4500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 CORPORATE SQUARE BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322161941",
"telephone_number": "904-899-4500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMAS",
"first_name": "ETHAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-02-16",
"last_updated": "2015-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CO",
"license": "LPC5362",
"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 Jun 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.