ETHEREAL COUNSELING CENTER LLC
NPI 1164188496
Counselor - Mental Health in Jacksonville, FL
About Ethereal Counseling Center Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ETHEREAL COUNSELING CENTER LLC (NPI 1164188496) is a healthcare organization registered as a mental health in Jacksonville, Florida and active in the NPI registry since November 2021. The organization lists Dana Weiss, Credentialing Specialist, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Ethereal Counseling Center Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Ethereal Counseling Center LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Ethereal Counseling Center LLC's NPI number?
The NPI number for Ethereal Counseling Center LLC is 1164188496. It was assigned to this organization in the NPPES registry on November 10, 2021.
Where is Ethereal Counseling Center LLC located?
Ethereal Counseling Center LLC is located at 10035 Bengal Fox Dr, Jacksonville, FL 32222. The listed phone number is (904) 515-3326.
What is Ethereal Counseling Center LLC's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.
Is Ethereal Counseling Center LLC enrolled in Medicare?
Yes. Ethereal Counseling Center LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Ethereal Counseling Center LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Mental Health Counselor) reassigns their Medicare billing to Ethereal Counseling Center LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Ethereal Counseling Center LLC was last updated on July 24, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Ethereal Counseling Center Llc · NPI 1164188496
Mental Health organization in Jacksonville, Florida. Organization record, active in the CMS NPPES registry since November 10, 2021.
## Identity
- **NPI:** 1164188496 (Entity type: Organization)
- **Enumerated:** November 10, 2021
- **Primary specialty:** Counselor - Mental Health · taxonomy 101YM0800X
- **Organization subpart:** No
- **Authorized official:** Dana Weiss, CREDENTIALING SPECIALIST
## Practice location
- **Address:** 10035 BENGAL FOX DR, Jacksonville, FL 32222-2895
- **Phone:** (904) 515-3326
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Mental Health Counselor) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 24, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1164188496) · Data from the CMS NPPES public registry.