Mara's Lighthouse Counseling Center, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

MARA'S LIGHTHOUSE COUNSELING CENTER, LLC

Practice address

6015 Morrow St E Ste 109
Jacksonville, FL 32217-2125

Phone

(904) 990-8105

Fax

(904) 562-3359

NPI assigned

Dec 19, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stephanie Ingenito

Title

Credentialing Specialists

Phone

(570) 352-3063

Specialties & licenses 1

Addresses

Tax ID family

Maras Lighthouse Counseling Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mara's Lighthouse Counseling Center, LLC

  • Clinical Social Worker
  • Jacksonville, FL
  • NPI 1407478613
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shamara Gibson, LCSW

  • Clinical Social Worker
  • Jacksonville, FL
  • NPI 1598140733
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545177600000",
    "number": "1962974766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6015 MORROW ST E STE 109",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322172125",
            "telephone_number": "904-990-8105",
            "fax_number": "904-562-3359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6015 MORROW ST E STE 109",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322172125",
            "telephone_number": "904-990-8105",
            "fax_number": "904-562-3359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARA'S LIGHTHOUSE COUNSELING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-19",
        "last_updated": "2018-12-19",
        "status": "A",
        "authorized_official_last_name": "INGENITO",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALISTS",
        "authorized_official_telephone_number": "570-352-3063"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Lynn Maples, PAS2
• Stacy Maples
• William James Maples, M.D.
• Mara Health Centers LLC
• Mara's Lighthouse Counseling Center, LLC
• Todd Marabanian, PA-C
• Paul P Maraj, M.D.
• Nang Aung Maran, MSN, APRN, AGACNP-BC
• Nizar Fuad Maraqa, MD
• Amani Omar Marar

• Mental Health Clinic/Center (Including Community Mental Health Center) in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 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.

Verify at the official NPI Registry.