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ETHEREAL COUNSELING CENTER LLC
NPI 1164188496
Counselor - Mental Health in Jacksonville, FL

Active since November 10, 2021
10035 BENGAL FOX DR, JACKSONVILLE, FL 32222(904) 515-3326 Get Directions Write a Review

NPPES record last updated: July 24, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jul 24, 2023, Nov 10, 2021 (2 updates tracked since 2021).

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

NPI1164188496
Entity TypeOrganization
Primary Taxonomy101YM0800X
Legal Business NameETHEREAL COUNSELING CENTER LLC
Location Address10035 BENGAL FOX DRJacksonville, FL 32222-2895
Mailing Address10035 Bengal Fox DrJacksonville, FL 32222-2895 · (904) 515-3326
Phone(904) 515-3326
Organization SubpartNo
Authorized OfficialDana WeissCredentialing Specialist · (904) 701-3076
Enumeration DateNovember 10, 2021
Last NPPES UpdateJuly 24, 20232 updates tracked since enumeration
NPPES CertifiedJuly 24, 2023
✔ NPI 1164188496 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
Also ListedMarriage & Family TherapistTaxonomy 106H00000X
10035 BENGAL FOX DR, Jacksonville, FL 32222
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

YOLLA N BADDOUR LMHC
Counselor (Mental Health)
10035 BENGAL FOX DR
JACKSONVILLE, FL 32222
Duval County (516) 306-6497

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.

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 with the weekly NPPES data releases published by CMS.