RANDY ELY (NPI# 1902395254) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902395254 |
| Entity Type | Individual |
| Full Name | RANDY ELY |
| Credential | RMHCI |
| Practice Address |
6867 Southpoint Dr N Jacksonville FL 32216-8043 |
| Practice Telephone | 9046196071 |
| Practice Fax Number | 9042120309 |
| Mailing Telephone | 9046196071 |
| Mailing Fax Number | 9042120309 |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2018-05-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
IMHI7070 | FL | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | FL HEALTH LICENSE | IMH17070 | 01 |
| Street Address |
6867 SOUTHPOINT DR N |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32216-8043 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043395288 | Susan Pitts Angel | Nurse Practitioner | 6867 Southpoint Dr N, Suite 101, Jacksonville, FL 32216-8043 | 2006-10-26 |
| 1326526302 | Gary Incremona | Behavior Technician | 6867 Southpoint Dr N, Jacksonville, FL 32216-8043 | 2018-08-01 |
| 1124519145 | Mallory Lynn Butler | Speech-Language Pathologist | 6867 Southpoint Dr N, Jacksonville, FL 32216-8043 | 2018-05-24 |
| 1952808420 | Christina Bornmann | Occupational Therapist | 6867 Southpoint Dr N, Jacksonville, FL 32216-8043 | 2018-04-10 |
| 1841793171 | Seven Bridges Therapies LLC | Psychologist | 6867 Southpoint Dr N, Jacksonville, FL 32216-8043 | 2018-03-13 |
| 1669974283 | Morgan Leigh Williamson | Behavior Technician | 6867 Southpoint Dr N, Jacksonville, FL 32216-8043 | 2018-02-28 |
| 1063912558 | Ashley Weaver | Developmental Therapist | 6867 Southpoint Dr N, Jacksonville, FL 32216-8043 | 2018-02-20 |
| 1124531355 | Toni Hopkins | Behavior Technician | 6867 Southpoint Dr N, Jacksonville, FL 32216-8043 | 2017-11-09 |
| 1497266985 | Sara Baraso | Behavior Technician | 6867 Southpoint Dr N, Jacksonville, FL 32216-8043 | 2017-10-24 |
| 1992214100 | Vidhya Scimeme | Behavior Technician | 6867 Southpoint Dr N, Jacksonville, FL 32216-8043 | 2017-09-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013524925 | Renee Cherie Titus | Behavior Technician | Growing Together Center 6789 Southpoint Parkway, Building 100, Jacksonville, FL 32216 | 2020-09-24 |
| 1811546575 | First Coast Orthopedic Center, LLC | Clinic/Center | 4035 Southpoint Boulevard, Jacksonville, FL 32216 | 2019-09-05 |
| 1922578558 | Fatima Hussain Crofton | Optometrist | 7051 Southpoint Parkway S 300, Jacksonville, FL 32216 | 2018-11-27 |
| 1154802833 | John-paul Pham | Internal Medicine | 4141 Southpoint Drive East, Suite D, Jacksonville, FL 32216 | 2018-08-22 |
| 1790279479 | Joseph Richard Kennedy | Physician Assistant | 6650 Corporate Center Pkwy Apt 1604, Jacksonville, FL 32216 | 2018-06-18 |
| 1801304357 | Kelli M. Tyson | Nurse Practitioner | 3550 University Blvd. S., Ste 302, Jacksonville, FL 32216 | 2018-01-18 |
| 1376054809 | Angela M Whittinghill | Counselor | 8833 Perimeter Park Blvd #702, Jacksonville, FL 32216 | 2017-10-24 |
| 1629508072 | Zoryana Yufan | Dentist | 8750 Perimeter Park Blvd Ste 101, Jacksonville, FL 32216 | 2017-06-19 |
| 1700318896 | Christina Kaczmarek | Behavior Technician | 6816 Southpoint Pkwy Ste 500, Jacksonville, FL 32216 | 2017-03-29 |
| 1932640422 | Loudine Racius | Nurse Practitioner | 8539 Gate Parkway W, Unit 1422, Jacksonville, FL 32216 | 2017-03-16 |
| Find all providers in zip 32216 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134720519 | Ashley Harms | Counselor | 4070 Herschel St Ste 1, Jacksonville, FL 32210-2239 | 2020-11-03 |
| 1902418684 | Molly Ann Burkhardt | Counselor | 5776 Saint Augustine Rd # 8030, Jacksonville, FL 32207-8046 | 2020-08-23 |
| 1194335638 | Aiteria Green | Counselor | 9713 Bridgeway Ave, Jacksonville, FL 32222-2913 | 2020-08-07 |
| 1053920116 | Barbara Burden | Counselor | 209 N Carole Dr, Jacksonville, NC 28546-4845 | 2020-07-24 |
| 1790393973 | Kelley Holladay | Counselor | 1782 Plantation Oaks Dr, Jacksonville, FL 32223-5010 | 2020-07-14 |
| 1629696646 | Mary Ann Caldwell | Counselor | 2496 Northwoods Dr., Jacksonville, NC 28540 | 2020-07-07 |
| 1447877709 | Quendria Johnson-kerns | Counselor | 200 Zonnie Ln, Jacksonville, NC 28540-9729 | 2020-07-02 |
| 1467077164 | Shanna Horan | Counselor | 13500 Sutton Park Dr S Ste 702, Jacksonville, FL 32224-5290 | 2020-06-09 |
| 1720602527 | Shannon E Raikes | Counselor | 13990 Bartram Park Blvd Unit 209, Jacksonville, FL 32258-5543 | 2020-06-08 |
| 1750905253 | Kathlena N Reed | Counselor | 4131 University Blvd S Fl 32216, Jacksonville, FL 32216-4326 | 2020-06-01 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32216 |
Please comment or provide details below to improve the information on RANDY ELY.
| 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.