Individual provider Active NPI

Gloria Santiago, LMHC

  • Mental Health Counselor
  • Kissimmee, FL
National Provider Identifier
1053893800
Registry record updated Nov 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH23625 Issued in FL
Practice address
321 W Oak St
Kissimmee, FL 34741-4421
Phone
(833) 769-3524
NPI assigned
Aug 29, 2018
Last updated
Nov 22, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X MH23625 FL Primary

Addresses

Primary practice location

321 W Oak St
Kissimmee, FL 34741-4421

Mailing address

321 W Oak St
Kissimmee, FL 34741-4421
Phone (407) 875-3700

Other practice location 1

1800 Mercy Dr
Orlando, FL 32808-5646
Phone (407) 875-3700

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240426001140 FL Practitioner - Mental Health Counselor 8628418415 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Personal Recovery Network LLCGroup PAC ID 5092611384, 612 clinicians

Practice addresses (Care Compare)

321 W Oak St
Lifestance Health
Kissimmee, FL 34741-4421
Phone (407) 537-9452

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Personal Recovery Network LLC CurrentSince Jun 17, 2024 Accepting new patients

Locations

4800 N Scottsdale Rd
Ste 2500
Scottsdale, AZ 85251
Phone (253) 346-0392

321 W Oak St
Kissimmee, FL 34741
Phone (321) 594-5801

260 Lookout Pl
Ste 202
Maitland, FL 32751
Phone (407) 537-9450

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1535500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732233600000",
    "number": "1053893800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 W OAK ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347414421",
            "telephone_number": "407-875-3700",
            "fax_number": "407-659-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 W OAK ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347414421",
            "telephone_number": "833-769-3524"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 Mercy Dr",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328085646",
            "country_code": "US",
            "telephone_number": "407-875-3700",
            "fax_number": "407-659-0411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANTIAGO",
        "first_name": "GLORIA",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-29",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH23625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.