Individual provider Active NPI

Richard Jerrid Dewalden, LMHC

  • Mental Health Counselor
  • Minneola, FL
National Provider Identifier
1104788827
Registry record updated Dec 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH11314 Issued in FL
Practice address
881 Boxelder Ave
Minneola, FL 34715-6095
Phone
(407) 761-3953
NPI assigned
Dec 1, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 1, 2025

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 MH11314 FL Primary

Addresses

Primary practice location

881 Boxelder Ave
Minneola, FL 34715-6095

Mailing address

881 Boxelder Ave
Minneola, FL 34715-6095
Phone (407) 761-3953

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
MH11314FLMDMental Health Counselor

NPI Registry JSON

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

{
    "created_epoch": "1764547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764547200000",
    "number": "1104788827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "881 BOXELDER AVE",
            "city": "MINNEOLA",
            "state": "FL",
            "postal_code": "347156095",
            "telephone_number": "407-761-3953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "881 BOXELDER AVE",
            "city": "MINNEOLA",
            "state": "FL",
            "postal_code": "347156095",
            "telephone_number": "407-761-3953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWALDEN",
        "first_name": "RICHARD",
        "middle_name": "JERRID",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-12-01",
        "last_updated": "2025-12-01",
        "certification_date": "2025-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH11314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneola, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2025; 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.