NPIMap

Organization Active NPI

Phyllis McColister-Cunningham PA

  • Community/Behavioral Health Agency
  • Fort Pierce, FL
National Provider Identifier
1245766807
Registry record updated Dec 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MH14456 Issued in FL
Legal business name
PHYLLIS MCCOLISTER-CUNNINGHAM PA
Practice address
900 Virginia Ave Ste 7
Fort Pierce, FL 34982-5882
Phone
(772) 448-4189
Fax
(772) 245-4259
NPI assigned
May 2, 2017
Last updated
Dec 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2023

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

Authorized official

Name
Phyllis McColister-CunninghamNPI 1760891121
Title
Ceo & Owner
Phone
(772) 448-4189

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X MH14456 FL Primary

Addresses

Primary practice location

900 Virginia Ave Ste 7
Fort Pierce, FL 34982-5882

Mailing address

900 Virginia Ave Ste 7
Fort Pierce, FL 34982-5882
Phone (772) 448-4189

National Provider Directory

National Provider Directory
Tax ID family
Healing Waters Counseling2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

900 Virginia Ave
Ste 7
Fort Pierce, FL 34982
Phone (772) 448-4189

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1493683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701734400000",
    "number": "1245766807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 VIRGINIA AVE STE 7",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349825882",
            "telephone_number": "772-448-4189",
            "fax_number": "772-245-4259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 VIRGINIA AVE STE 7",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349825882",
            "telephone_number": "772-448-4189",
            "fax_number": "772-245-4259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYLLIS MCCOLISTER-CUNNINGHAM PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-02",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A",
        "authorized_official_last_name": "MCCOLISTER-CUNNINGHAM",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_title_or_position": "CEO & OWNER",
        "authorized_official_telephone_number": "772-448-4189"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "MH14456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Pierce, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; 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.