Ethereal Counseling Center LLC
NPI 1164188496 · Mental Health Counselor · Jacksonville, FL
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Ethereal Counseling Center LLC is a Mental Health Counselor organization in Jacksonville, FL (NPI 1164188496).
Provider details
- NPI number
- 1164188496
- Entity type
- Organization
- Primary specialty
- Mental Health CounselorBehavioral Health & Social Service Providers
- Organization subpart
- No
- Authorized official
- Dana Weiss, Credentialing Specialist(904) 701-3076
Specialties & taxonomies
Behavioral Health & Social Service Providers
- Marriage & Family Therapist106H00000X
Behavioral Health & Social Service Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
4 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2021-11-10
- Last updated
- 2023-07-24
- Certified
- 2023-07-24
Frequently asked questions
- What is Ethereal Counseling Center LLC's NPI number?
- Ethereal Counseling Center LLC's National Provider Identifier (NPI) is 1164188496, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Ethereal Counseling Center LLC?
- Ethereal Counseling Center LLC is classified in the NPPES registry as Mental Health Counselor (Behavioral Health & Social Service Providers).
- Where is Ethereal Counseling Center LLC located?
- Ethereal Counseling Center LLC's practice location on file with NPPES is 10035 Bengal Fox Dr, Jacksonville, FL 32222-2895.
- What is Ethereal Counseling Center LLC's phone number?
- The practice phone number listed in the NPPES registry for Ethereal Counseling Center LLC is (904) 515-3326.
- Does Ethereal Counseling Center LLC accept Medicare?
- Ethereal Counseling Center LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Ethereal Counseling Center LLC?
- The authorized official listed on Ethereal Counseling Center LLC's NPPES record is Dana Weiss, Credentialing Specialist. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Ethereal Counseling Center LLC's NPI active?
- Yes — Ethereal Counseling Center LLC's NPI (1164188496) is active in the NPPES registry as of the last update on 2023-07-24.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.