NPIMap

Organization Active NPI

Authentic Self Counseling of Jacksonville, LLC

  • Mental Health Counselor
  • Fernandina Beach, FL
National Provider Identifier
1982369625
Registry record updated Nov 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
AUTHENTIC SELF COUNSELING OF JACKSONVILLE, LLC
Practice address
910 S 8TH St Ste 100
Fernandina Beach, FL 32034-3745
Phone
(904) 894-3867
NPI assigned
Nov 8, 2021
Last updated
Nov 8, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2021

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

Authorized official

Name
Michelle AndersonNPI 1184192866
Title
Owner
Phone
(904) 990-7117

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

910 S 8TH St Ste 100
Fernandina Beach, FL 32034-3745

Mailing address

910 S 8TH St Ste 100
Fernandina Beach, FL 32034-3745
Phone (904) 894-3867

National Provider Directory

National Provider Directory
Tax ID family
Authentic Self Counseling of Jacksonville LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1636329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636329600000",
    "number": "1982369625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 S 8TH ST STE 100",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320343745",
            "telephone_number": "904-894-3867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 S 8TH ST STE 100",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320343745",
            "telephone_number": "904-894-3867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTHENTIC SELF COUNSELING OF JACKSONVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-08",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-990-7117"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fernandina Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; 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.