Individual provider Active NPI

Casandra Merritt

  • Mental Health Counselor
  • Brandon, FL
National Provider Identifier
1205239357
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
IMH 12768 Issued in FL
Practice address
135 N Moon Ave
Brandon, FL 33510-4419
Phone
(813) 489-4547
Fax
(813) 381-5140
NPI assigned
Oct 3, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X CBHCMS100611 FL
Mental Health Counselor 101YM0800X IMH 12768 FL Primary

Addresses

Primary practice location

135 N Moon Ave
Brandon, FL 33510-4419

Mailing address

135 N Moon Ave
Brandon, FL 33510-4419
Phone (813) 489-4547

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
IMH 12768FLMDMental Health Counselor
CBHCMS100611FLMDCase Manager/Care Coordinator

Practice roles

OrganizationSpecialtyStatusNew patients
Start Fresh Counseling Center, Inc Mental Health Current Accepting new patients
New Journey Counseling Center LLC Mental Health Current Accepting new patients

Locations

135 N Moon Ave
Brandon, FL 33510
Phone (813) 489-4547

1463 Oakfield Dr
Ste 117
Brandon, FL 33511
Phone (813) 489-4547

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": "1412294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644451200000",
    "number": "1205239357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 N MOON AVE",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335104419",
            "telephone_number": "813-489-4547",
            "fax_number": "813-381-5140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 N MOON AVE",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335104419",
            "telephone_number": "813-489-4547",
            "fax_number": "813-381-5140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERRITT",
        "first_name": "CASANDRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-03",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "FL",
            "license": "CBHCMS100611",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "IMH 12768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; 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.