Individual provider Active NPI

Daniele Alexis Trevathan, LMHC, QS, CAP

  • Mental Health Counselor
  • Boca Raton, FL
National Provider Identifier
1174990667
Registry record updated Aug 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH12256 Issued in FL
Practice address
160 W Camino Real # 508
Boca Raton, FL 33432-5942
Phone
(561) 463-2073
NPI assigned
Aug 31, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X ADC0012622014 FL
Mental Health Counselor 101YM0800X MH12256 FL Primary

Addresses

Primary practice location

160 W Camino Real # 508
Boca Raton, FL 33432-5942

Mailing address

160 W Camino Real # 508
Boca Raton, FL 33432-5942
Phone (561) 463-2073

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20240918003685 FL Practitioner - Mental Health Counselor 0648711523 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grow Healthcare Group PAGroup PAC ID 3476961368, 1,045 clinicians

Practice addresses (Care Compare)

66 E Flagler St
Miami, FL 33130-1807
Phone (786) 244-7711

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ADC0012622014FLMDAddiction (Substance Use Disorder) Counselor
MH12256FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Mental Health CurrentSince Aug 13, 2024 Accepting new patients
Me Time Healing LLC Addiction (Substance Use Disorder) Past Accepting new patients

Locations

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

Organizations & group practices 2

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": "1440979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723161600000",
    "number": "1174990667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 W CAMINO REAL # 508",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334325942",
            "telephone_number": "561-463-2073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 W CAMINO REAL # 508",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334325942",
            "telephone_number": "561-463-2073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TREVATHAN",
        "first_name": "DANIELE",
        "middle_name": "ALEXIS",
        "name_prefix": "Mrs.",
        "credential": "LMHC, QS, CAP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-31",
        "last_updated": "2024-08-09",
        "certification_date": "2024-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "ADC0012622014",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH12256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

Verify at the official NPI Registry.