Individual provider Active NPI

John S Wilks-Young Jr.

  • Mental Health Counselor
  • Fort Pierce, FL
National Provider Identifier
1245874312
Registry record updated Aug 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH21712 Issued in FL
Practice address
985 Seaway Dr
Fort Pierce, FL 34949-2744
Phone
(772) 577-0405
NPI assigned
Nov 1, 2019
Last updated
Aug 20, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 20, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 2773 NH
Mental Health Counselor 101YM0800X MH21712 FL Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X

Addresses

Primary practice location

985 Seaway Dr
Fort Pierce, FL 34949-2744

Mailing address

985 Seaway Dr
Fort Pierce, FL 34949-2744
Phone (772) 577-0405

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, NH2 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
I20240702004531 FL Practitioner - Mental Health Counselor 1052855962 Reassigns benefits to 2 organizations
I20250205002311 NH Practitioner - Mental Health Counselor 1052855962 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MH21712FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Embrace Wellness Center LLC CurrentSince Sep 1, 2024 Accepting new patients
Grow Healthcare Group PA Mental Health CurrentSince May 28, 2024 Accepting new patients
Sondermind Provider Network LLC Professional CurrentSince Feb 1, 2026 Accepting new patients
Shine Medical Providers PC Past Accepting new patients

Locations

985 Seaway Dr
Fort Pierce, FL 34949
Phone (407) 545-1258

985 Seaway Dr
Ste B
Fort Pierce, FL 34949

333 SE 2nd Ave
Ste 2000
Miami, FL 33131
Phone (201) 581-3411

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

15 Constitution Dr
Bedford, NH 03110
Phone (603) 472-7233

170 Commerce Way
Ste 200
Portsmouth, NH 03801
Phone (201) 293-7689

Organizations & group practices 4

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": "1572566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755648000000",
    "number": "1245874312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "985 SEAWAY DR",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349492744",
            "telephone_number": "772-577-0405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "985 SEAWAY DR",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349492744",
            "telephone_number": "772-577-0405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKS-YOUNG",
        "first_name": "JOHN",
        "middle_name": "S",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-11-01",
        "last_updated": "2025-08-20",
        "certification_date": "2025-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NH",
            "license": "2773",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH21712",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Pierce, FL

Sources for this page

Verify at the official NPI Registry.