Active NPI
Randy Ely, RMHCI
- Mental Health Counselor
- Jacksonville, FL
National Provider Identifier
1902395254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- IMHI7070
- Practice address
- 6867 Southpoint Dr N
Jacksonville, FL 32216-8043 - Phone
- (904) 619-6071
- Fax
- (904) 212-0309
- NPI assigned
- May 2, 2018
- 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 | IMHI7070 | FL | Primary |
Addresses
Primary practice location
6867 Southpoint Dr N
Jacksonville, FL 32216-8043
Mailing address
6867 Southpoint Dr N
Jacksonville, FL 32216-8043
Phone (904) 619-6071
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| IMH17070 | Other | FL | FL HEALTH LICENSE |
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 |
|---|---|---|---|
| IMHI7070 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525219200000",
"number": "1902395254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6867 SOUTHPOINT DR N",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322168043",
"telephone_number": "904-619-6071",
"fax_number": "904-212-0309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6867 SOUTHPOINT DR N",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322168043",
"telephone_number": "904-619-6071",
"fax_number": "904-212-0309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELY",
"first_name": "RANDY",
"credential": "RMHCI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-02",
"last_updated": "2018-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "IMHI7070",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FL HEALTH LICENSE",
"identifier": "IMH17070",
"state": "FL"
}
],
"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 May 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.