Individual provider Active NPI

Kristin Crumbley, LMHC, LMFT

  • Mental Health Counselor
  • Daytona Beach, FL
National Provider Identifier
1164047106
Registry record updated Jun 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
17903 Issued in FL
Practice address
240 N Frederick Ave
Daytona Beach, FL 32114
Phone
(386) 675-0118
NPI assigned
Jun 16, 2020
Last updated
Jun 16, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 16, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 17903 FL Primary
Marriage & Family Therapist 106H00000X 3816 FL

Addresses

Primary practice location

240 N Frederick Ave
Daytona Beach, FL 32114

Mailing address

240 N Frederick Ave
Daytona Beach, FL 32114-3400
Phone (386) 675-0098

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL wendy_seavers@outreachinc.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 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
I20241003004177 FL Practitioner - Marriage and Family Therapist 4688097934 Reassigns benefits to 2 organizations
I20241115000261 FL Practitioner - Mental Health Counselor 4688097934 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
17903FLMDMental Health Counselor
3816FLMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Mental Health CurrentSince Aug 27, 2024 Accepting new patients
Brave Health Inc. CurrentSince Nov 1, 2024 Accepting new patients
Florida United Methodist Children's Home Inc. Past Accepting new patients

Locations

1951 NW 7th Ave
Fl 3
Miami, FL 33136
Phone (305) 297-4749

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

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, 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": "1592265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592265600000",
    "number": "1164047106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 N FREDERICK AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321143400",
            "telephone_number": "386-675-0098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 N FREDERICK AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "32114",
            "telephone_number": "386-675-0118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUMBLEY",
        "first_name": "KRISTIN",
        "credential": "LMHC, LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-16",
        "last_updated": "2020-06-16",
        "certification_date": "2020-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "17903",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "FL",
            "license": "3816",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "wendy_seavers@outreachinc.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "240 N Frederick Ave",
            "city": "Daytona Beach",
            "state": "FL",
            "country_code": "US",
            "postal_code": "321143400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

Verify at the official NPI Registry.