Individual provider Active NPI

Jessica Tandy Lyrek, LMFT

  • Marriage & Family Therapist
  • Fort Myers, FL
National Provider Identifier
1104639095
Registry record updated Jun 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MT5136 Issued in FL
Practice address
6440 Neal Rd
Fort Myers, FL 33905-6828
Phone
(612) 267-5107
NPI assigned
Jan 27, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MT5136 FL Primary

Addresses

Primary practice location

6440 Neal Rd
Fort Myers, FL 33905-6828

Mailing address

6440 Neal Rd
Fort Myers, FL 33905-6828
Phone (612) 267-5107

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, SC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20250218001836 FL Practitioner - Marriage and Family Therapist 8123548401 Reassigns benefits to 2 organizations
I20260219000096 SC Practitioner - Marriage and Family Therapist 8123548401 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

66 E Flagler St
Miami, FL 33130-1807

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8352SCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Bonita Springs Retirement Village, Inc. CurrentSince Feb 14, 2025 Accepting new patients
Grow Healthcare Group PA Marriage & Family Therapist CurrentSince Feb 14, 2025 Accepting new patients
Dna Comprehensive Therapy Services, LLC CurrentSince Feb 14, 2025 Accepting new patients

Locations

4310 Metro Pkwy
Ste 205
Fort Myers, FL 33916

228 Plaza Dr
Ste D
Lehigh Acres, FL 33936
Phone (239) 491-8204

2913 Lee Blvd
Lehigh Acres, FL 33971
Phone (239) 368-9900

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

3191 Harbor Blvd
Ste A
Pt Charlotte, FL 33952
Phone (941) 766-9555

170 Meeting St
Ste 110
Charleston, SC 29401
Phone (704) 610-1304

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1737936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748995200000",
    "number": "1104639095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6440 NEAL RD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339056828",
            "telephone_number": "612-267-5107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6440 NEAL RD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339056828",
            "telephone_number": "612-267-5107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYREK",
        "first_name": "JESSICA",
        "middle_name": "TANDY",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-01-27",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "FL",
            "license": "MT5136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.