Individual provider Active NPI

Evelyn Diaz Gomez, LMHC

  • Mental Health Counselor
  • Orlando, FL
National Provider Identifier
1275908220
Registry record updated Feb 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH17196 Issued in FL
Practice address
6900 Tavistock Lakes Blvd. Suite 400
Orlando, FL 32827-7593
Phone
(407) 906-0331
NPI assigned
Dec 2, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X MH17196 FL Primary

Addresses

Primary practice location

6900 Tavistock Lakes Blvd. Suite 400
Orlando, FL 32827-7593

Mailing address

6900 Tavistock Lakes Blvd. Suite 400
Orlando, FL 32827-7593
Phone (407) 906-0331

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective May 27, 2025 through May 27, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
MH17196FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Sunrise Counseling, LLC Current Accepting new patients
Behavioral Support Services, Inc. Past Accepting new patients

Locations

6900 Tavistock Lakes Blvd
Ste 400
Orlando, FL 32827
Phone (407) 967-0446

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": "1449014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738454400000",
    "number": "1275908220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6900 TAVISTOCK LAKES BLVD. SUITE 400",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328277593",
            "telephone_number": "407-906-0331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 TAVISTOCK LAKES BLVD. SUITE 400",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328277593",
            "telephone_number": "407-906-0331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ GOMEZ",
        "first_name": "EVELYN",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-02",
        "last_updated": "2025-02-02",
        "certification_date": "2025-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH17196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.