Active NPI
Jerry Franklin Phillips, LMHC
- Mental Health Counselor
- Melbourne, FL
National Provider Identifier
1114103751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- M-4358
- Practice address
- 4160 Millicent Cir
Melbourne, FL 32901-6716 - Phone
- (334) 322-5750
- NPI assigned
- Jan 14, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | M-4358 | FL | Primary |
Addresses
Primary practice location
4160 Millicent Cir
Melbourne, FL 32901-6716
Mailing address
4160 Millicent Cir
Melbourne, FL 32901-6716
Phone (334) 322-5750
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| M-4358 | Other | FL | LMHC |
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
| License | State | Type | Specialty |
|---|---|---|---|
| M-4358 | FL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Upper Room Counseling Center, Inc. | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Mental Health Counselor
- Fruitland Park, FL
- NPI 1134439235
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1741737600000",
"number": "1114103751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4160 MILLICENT CIR",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329016716",
"telephone_number": "334-322-5750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4160 MILLICENT CIR",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329016716",
"telephone_number": "334-322-5750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "JERRY",
"middle_name": "FRANKLIN",
"credential": "LMHC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-01-14",
"last_updated": "2025-03-12",
"certification_date": "2025-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "M-4358",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LMHC",
"identifier": "M-4358",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 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.