Bayou Wellness, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH12035 Issued in FL

Legal business name

BAYOU WELLNESS, LLC

Practice address

69 Bay Bridge Dr
Suite H
Gulf Breeze, FL 32561-4468

Phone

(850) 324-7912

NPI assigned

Jun 26, 2015

Organization subpart

No

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

Authorized official

Name

Ms. Andrea Burks, LMHC

Title

Owner

Phone

(850) 324-7912

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Greunke, LCSW

  • Clinical Social Worker
  • Gulf Breeze, FL
  • NPI 1194266098
  NPD (past)
• Ruth Valeria Trigonis-Quesada, LCSW

  • Clinical Social Worker
  • Gulf Breeze, FL
  • NPI 1942833215
  NPD (past)

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

{
    "created_epoch": "1435276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435276800000",
    "number": "1083096036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 BAY BRIDGE DR",
            "address_2": "SUITE H",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325614468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 BAY BRIDGE DR",
            "address_2": "SUITE H",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325614468",
            "telephone_number": "850-324-7912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYOU WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-26",
        "last_updated": "2015-06-26",
        "status": "A",
        "authorized_official_last_name": "BURKS",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-324-7912",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH12035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Basile
• Samantha Bass, RBT
• Carina Bauerdorf, RBT
• Bay Breeze Operating Investments LLC
• Baybridge Chiropractic Clinic, P.a.
• Gregory L Beach, FNP
• Rick A Beach, M.D.
• Casey Wheeler Becker, M.A., LMHC
• Behavior Changes LLC
• Behive Homes of Pensacola, LLC (Beehive Homes of Gulf Breeze)

• Mental Health Counselor in Gulf Breeze, FL
• Providers in Gulf Breeze, 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 Jun 26, 2015; 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.