Kelly Jennings, MH 21536

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH21536 Issued in FL

Practice address

858 S Duncan Dr
Tavares, FL 32778-4044

Phone

(352) 609-5103

NPI assigned

Jan 4, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Life Counseling CenterGroup PAC ID 0648623835, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family Life Counseling Center

  • Mental Health Counselor
  • Clermont, FL
  • NPI 1033665260
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1672790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1043923147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 TYRINGHAM RD",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "32726",
            "telephone_number": "352-354-4004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "858 S DUNCAN DR",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327784044",
            "telephone_number": "352-609-5103"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9100 Conroy Windermere Rd",
            "address_purpose": "LOCATION",
            "city": "Windermere",
            "state": "FL",
            "postal_code": "347868431",
            "country_code": "US",
            "telephone_number": "352-708-6283",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "210 N Highway 27 Ste 4",
            "address_purpose": "LOCATION",
            "city": "Clermont",
            "state": "FL",
            "postal_code": "347112411",
            "country_code": "US",
            "telephone_number": "352-708-6283",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 S Kentucky Ave",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338015096",
            "country_code": "US",
            "telephone_number": "352-708-6283",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1965 S Orange Blossom Trl",
            "address_purpose": "LOCATION",
            "city": "Apopka",
            "state": "FL",
            "postal_code": "327037757",
            "country_code": "US",
            "telephone_number": "352-708-6283",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "858 S Duncan Dr",
            "address_purpose": "LOCATION",
            "city": "Tavares",
            "state": "FL",
            "postal_code": "327784044",
            "country_code": "US",
            "telephone_number": "352-708-6283",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JENNINGS",
        "first_name": "KELLY",
        "credential": "MH 21536",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-04",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH21536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kellyj@familylife.group",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "858 S Duncan Dr",
            "city": "Tavares",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327784044",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kellyj@familylife.group",
            "affiliation": "N",
            "endpointDescription": "kellyj@familylife.group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Other",
            "address_1": "858 S Duncan Dr",
            "city": "Tavares",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327784044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Counselor in Tavares, FL
• Providers in Tavares, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.