Active NPI
Candace Edwards, IMH18911
- Mental Health Counselor
- Tampa, FL
National Provider Identifier
1205273570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 10150 Highland Manor Dr.
Suite 200
Tampa, FL 33610 - Phone
- (813) 314-2200
- NPI assigned
- May 28, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 | Primary |
Addresses
Primary practice location
10150 Highland Manor Dr.
Suite 200
Tampa, FL 33610
Mailing address
1403 Cristo Rey PL
Plant City, FL 33566-8405
Phone (813) 400-4482
Other practice location 1
2255 Fluorshire Dr
Brandon, FL 33511-1307
Phone (813) 400-4482
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205273570 | Other | NPI |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | www.healingthebrokenheartllc.com | Other |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602547200000",
"number": "1205273570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1403 CRISTO REY PL",
"city": "PLANT CITY",
"state": "FL",
"postal_code": "335668405",
"telephone_number": "813-400-4482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10150 HIGHLAND MANOR DR.",
"address_2": "SUITE 200",
"city": "TAMPA",
"state": "FL",
"postal_code": "33610",
"telephone_number": "813-314-2200"
}
],
"practiceLocations": [
{
"address_1": "2255 Fluorshire Dr",
"address_purpose": "LOCATION",
"city": "Brandon",
"state": "FL",
"postal_code": "335111307",
"country_code": "US",
"telephone_number": "813-400-4482",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "EDWARDS",
"first_name": "CANDACE",
"credential": "IMH18911",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-05-28",
"last_updated": "2020-10-13",
"certification_date": "2020-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1205273570",
"state": null
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "www.healingthebrokenheartllc.com",
"affiliation": "N",
"endpointDescription": "Website",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "Contact",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Business information",
"address_1": "10150 Highland Manor Dr.",
"address_2": "Suite 200",
"city": "Tampa",
"state": "FL",
"country_code": "US",
"postal_code": "33610",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.