Active NPI
Jamie Fettig, LMHC
- Mental Health Counselor
- St Johns, FL
National Provider Identifier
1831713858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH14295
- Practice address
- 1665 Scott Rd
St Johns, FL 32259-9209 - Phone
- (484) 951-8754
- NPI assigned
- Jun 5, 2020
- 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 | MH14295 | FL | Primary |
Addresses
Primary practice location
1665 Scott Rd
St Johns, FL 32259-9209
Mailing address
1665 Scott Rd
St Johns, FL 32259-9209
Phone (484) 951-8754
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | fettigjamie@yahoo.com | Direct |
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 |
|---|---|---|---|
| MH14295 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591315200000",
"number": "1831713858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1665 SCOTT RD",
"city": "ST JOHNS",
"state": "FL",
"postal_code": "322599209",
"telephone_number": "484-951-8754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1665 SCOTT RD",
"city": "ST JOHNS",
"state": "FL",
"postal_code": "322599209",
"telephone_number": "484-951-8754"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FETTIG",
"first_name": "JAMIE",
"credential": "LMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-06-05",
"last_updated": "2020-06-05",
"certification_date": "2020-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH14295",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "fettigjamie@yahoo.com",
"affiliation": "N",
"endpointDescription": "secure email",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "1665 Scott Rd",
"city": "St Johns",
"state": "FL",
"country_code": "US",
"postal_code": "322599209",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in St Johns, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 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.