Krystal Antionette Farnum, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

150 S Pine Island Rd Ste 300
Plantation, FL 33324-2665

Phone

(570) 540-3465

NPI assigned

Jan 5, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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 and National Provider Directory roles.

• Shake It Up Foundation LLC

  dba Krystal Farnum

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Plantation, FL
  • NPI 1457983777
  NPD Authorized official
• Walk Tall Counseling Center LLC

  • Mental Health Counselor
  • Plantation, FL
  • NPI 1497382766
  NPD Authorized official

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

{
    "created_epoch": "1483574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585958400000",
    "number": "1063957611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6919 W BROWARD BLVD STE 151",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333172902",
            "telephone_number": "570-540-3465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 S PINE ISLAND RD STE 300",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333242665",
            "telephone_number": "570-540-3465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARNUM",
        "first_name": "KRYSTAL",
        "middle_name": "ANTIONETTE",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-05",
        "last_updated": "2020-04-04",
        "certification_date": "2020-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia M Fantoni-Salvador, PH.D.
• Michael Farag, DMD
• Marcelo Alves Farias II
• Sunaimy Faris
• Diamond Farmer, NP
• Barbara Marie Farrell, DO
• Mariya Fatakhova, PHARMD
• Faiz Fatteh, M.D.
• Naaz Fatteh, MD
• Shahnaz Fatteh, MD

• Mental Health Counselor in Plantation, FL
• Providers in Plantation, 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 Apr 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.