Individual provider Active NPI

David R Llewellyn

  • Mental Health Counselor
  • Estero, FL
National Provider Identifier
1083917207
Registry record updated Oct 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH11239 Issued in FL
Practice address
9180 Estero Park Commons Blvd
Suite 6
Estero, FL 33928-3218
Phone
(239) 595-3022
Fax
(239) 244-8404
NPI assigned
Dec 9, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2014

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 MH11239 FL Primary

Addresses

Primary practice location

9180 Estero Park Commons Blvd
Suite 6
Estero, FL 33928-3218

Mailing address

9180 Estero Park Commons Blvd
Suite 6
Estero, FL 33928-3218
Phone (239) 595-3022

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Apr 1, 2024 through Apr 1, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
MH11239FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Recovery Solutions, LLC Mental Health PastSince Aug 28, 2021 Accepting new patients
Harper & Harper LMHC LLC Mental Health PastSince Jun 9, 2024 Accepting new patients

Organizations & group practices 2

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": "1291852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412640000000",
    "number": "1083917207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9180 ESTERO PARK COMMONS BLVD",
            "address_2": "SUITE 6",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "339283218",
            "telephone_number": "239-595-3022",
            "fax_number": "239-244-8404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9180 ESTERO PARK COMMONS BLVD",
            "address_2": "SUITE 6",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "339283218",
            "telephone_number": "239-595-3022",
            "fax_number": "239-244-8404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LLEWELLYN",
        "first_name": "DAVID",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-09",
        "last_updated": "2014-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH11239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Estero, FL

Sources for this page

Verify at the official NPI Registry.