Misty Mountain Family Enrichment Center

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

MH 13637 Issued in FL

Legal business name

MISTY MOUNTAIN FAMILY ENRICHMENT CENTER

Doing business as

Southwest Florida Christian Counseling

Practice address

24840 Burnt Pine Dr
Suites 1 & 2
Bonita Springs, FL 34134-2999

Phone

(239) 301-4464

NPI assigned

Dec 13, 2009

Last updated

Aug 23, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Gregory Alan Hasek, MA/MFT LPC, LMHCNPI 1699004168

Title

Executive Director

Phone

(239) 301-4464

Specialties & licenses 1

Addresses

Other names 1

• Southwest Florida Christian Counseling Doing business as

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.

• Gregory Alan Hasek, MA/MFT LPC, LMHC

  • Mental Health Counselor
  • Bonita Springs, FL
  • NPI 1699004168
  NPD (past) Authorized official
• Tatjana Jobsky

  • Marriage & Family Therapist
  • Bonita Springs, FL
  • NPI 1912257452
  NPD (past)

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

{
    "created_epoch": "1260662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471910400000",
    "number": "1154650620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24840 BURNT PINE DR",
            "address_2": "SUITES 1 & 2",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341342999",
            "telephone_number": "239-301-4464",
            "fax_number": "503-684-6289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24840 BURNT PINE DR",
            "address_2": "SUITES 1 & 2",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341342999",
            "telephone_number": "239-301-4464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISTY MOUNTAIN FAMILY ENRICHMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-13",
        "last_updated": "2016-08-23",
        "status": "A",
        "authorized_official_last_name": "HASEK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "239-301-4464",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA/MFT LPC, LMHC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "MH 13637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwest Florida Christian Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mindescape LLC
• Mindful Musical Minds Behavior Solutions
• Timothy S Mingee, PA-C
• Mini Miracles Pediatrics Medical Daycare Inc
• Nicole Marie Minkley, LMT
• Annabel Delcarmen Montenegro, DENTAL HYGIENIST
• Mark Harlow Montgomery, M.D.
• Danielle Moore, BCBA
• Abbey Dupay Morales, D.M.D.
• Eduardo Jose Moreno Arturo, M.D

• Community/Behavioral Health Agency in Bonita Springs, FL
• Providers in Bonita Springs, FL by specialty
• Community/Behavioral Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2016; 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.