MR. JUSTIN TYLER BOLLINGMO (NPI# 1326436981) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326436981 |
| Entity Type | Individual |
| Full Name | MR. JUSTIN TYLER BOLLINGMO |
| Credential | LMFT |
| Practice Address |
12058 San Jose Blvd Ste 703 Jacksonville FL 32223-8668 |
| Practice Telephone | 9042600454 |
| Practice Fax Number | 9042600044 |
| Mailing Telephone | 9042060454 |
| Mailing Fax Number | 9042060044 |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2019-03-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106H00000X | Marriage & Family Therapist | 3292 | FL | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 820 Prudential Dr Ste 510, Jacksonville, FL 322078207 | 9043763800 | 9042022436 |
| Street Address |
12058 SAN JOSE BLVD STE 703 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32223-8668 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386768729 | Nancy Melcolm King | Social Worker | 12058 San Jose Blvd Ste 703, Jacksonville, FL 32223-8668 | 2007-03-19 |
| 1033651278 | Emily Stefanski | Counselor | 12058 San Jose Blvd Ste 703, Jacksonville, FL 32223 | 2016-11-04 |
| 1366800492 | Dawn Thomas | Massage Therapist | 12058 San Jose Blvd Ste 703, Jacksonville, FL 32223-8668 | 2016-02-03 |
| 1750758603 | Tanya Rigg | Counselor | 12058 San Jose Blvd Ste 703, Jacksonville, FL 32223-8668 | 2015-08-26 |
| 1336451210 | Marian Frances Keith | Counselor | 12058 San Jose Blvd Ste 703, Jacksonville, FL 32223-8668 | 2010-07-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679103600 | Karen Gabriela Alexander | Dietitian, Registered | Ackerman Cancer Center, 10881 San Jose Blvd, Jacksonville, FL 32223 | 2020-01-17 |
| 1891250049 | Thalia L Honea | Occupational Therapist | 12766 San Jose Blvd, Suite 716 & 717, Jacksonville, FL 32223 | 2019-02-01 |
| 1447758289 | Stephanie Ann Murphy | Marriage & Family Therapist | 11543 Halethorpe Drive, Jacksonville, FL 32223 | 2018-01-26 |
| 1861948481 | Nicole Gay | Developmental Therapist | 12276 San Jose Blvd, Ste 5, Jacksonville, FL 32223 | 2016-09-01 |
| 1740694439 | Robyn K Mizelle | Behavioral Analyst | 12276 San Jose Blvd. Great Strides Rehabilitation, Suite 507, Jacksonville, FL 32223 | 2014-06-20 |
| 1184038010 | Kelli Anne Cabrera | Occupational Therapist | 12350 San Jose Blvd, Jacksonville, FL 32223 | 2014-06-18 |
| 1891031910 | Mandarin Family Medicine, P.a. | Preferred Provider Organization | 12276-210 San Jose Blvd, Jacksonville, FL 32223 | 2012-12-18 |
| 1114201811 | Darshana Choksi | Pharmacist | 3663 Marbon Rd, Jacksonville, FL 32223 | 2011-09-30 |
| 1346539988 | Harris Wilcox and Donovan Pa | Optometrist | 11790 San Jose Bl, Jacksonville, FL 32223 | 2011-04-05 |
| 1740517796 | Beth A. Kelley | Occupational Therapist | 2640 Scott Mill Dr, Jacksonville, FL 32223 | 2009-11-12 |
| Find all providers in zip 32223 | ||||
| Taxonomy Code | 106H00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Marriage & Family Therapist |
| A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730730391 | Richard Painter | Marriage & Family Therapist | 6823 Argyle Forest Blvd, Jacksonville, FL 32244-5730 | 2019-09-25 |
| 1144874660 | Misty Williams | Marriage & Family Therapist | 3730 Oregon City St, Jacksonville, FL 32227-1719 | 2019-08-01 |
| 1356800080 | Lakisha Yolanda Carter | Marriage & Family Therapist | 4569 Cape Elizabeth Ct E, Jacksonville, FL 32277-3219 | 2019-03-12 |
| 1255805172 | Tracie Nickole Singh | Marriage & Family Therapist | 1125 W Beaver Street, Suite 205, Jacksonville, FL 32204 | 2019-01-14 |
| 1447758289 | Stephanie Ann Murphy | Marriage & Family Therapist | 11543 Halethorpe Drive, Jacksonville, FL 32223 | 2018-01-26 |
| 1518419514 | Kristina Himmelberg | Marriage & Family Therapist | 1100 Cesery Blvd., Jacksonville, FL 32211 | 2016-10-26 |
| 1881054591 | Virginia M. Boney, Ph.d. Lmft, Pa | Marriage & Family Therapist | 7545 Centurion Parkway, #105, Jacksonville, FL 32256 | 2016-02-24 |
| 1104248731 | Alicia Mcdermott | Marriage & Family Therapist | 7044 Deer Lodge Cir, #109, Jacksonville, FL 32256-8551 | 2014-01-16 |
| 1538500103 | Rashel Lee Lauret | Marriage & Family Therapist | 110 Branchwood Dr, Suite B, Jacksonville, NC 28546-5900 | 2013-07-11 |
| 1245589910 | Josephine Gianna Moss | Marriage & Family Therapist | 12629 Steeplechase Ln, Jacksonville, FL 32223-3506 | 2012-09-10 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32223 |
Please comment or provide details below to improve the information on MR. JUSTIN TYLER BOLLINGMO.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.