Deondrick Haughbrook – Mental Health Counselor

Key facts

NPI: 1306148184
Entity type: Individual (NPI type 1)
Primary specialty: Mental Health Counselor 101YM0800X
Practice address: 350 74TH Ave N Apt 211
Saint Petersburg, FL 33702-5423
Phone: (727) 641-1551
Fax: (727) 322-1573
NPI assigned: Nov 29, 2010
Sex: Male
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Mental Health Counselor	101YM0800X		FL	Yes

Addresses

Primary practice location

350 74TH Ave N Apt 211
Saint Petersburg, FL 33702-5423

Mailing address

350 74TH Ave N Apt 211
Saint Petersburg, FL 33702-5423
Phone (727) 641-1551

Other identifiers

Identifier	Type	State	Issuer
688900096	Medicaid	FL

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 29, 2010.

{
    "created_epoch": "1290988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290988800000",
    "number": "1306148184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 74TH AVE N APT 211",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337025423",
            "telephone_number": "727-641-1551",
            "fax_number": "727-322-1573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 74TH AVE N APT 211",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337025423",
            "telephone_number": "727-641-1551",
            "fax_number": "727-322-1573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAUGHBROOK",
        "first_name": "DEONDRICK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-11-29",
        "last_updated": "2010-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "688900096",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Petersburg, FL

Krystal Vivienne Patricia Hassan, FSD, CBC, CPPS,
David Michael Hassett, CAP
Brian J Hatlelid, PHYSICAL THERAPIST
Annmarie Hattala
Brandi R Haugabook, CNM
Haven Home Health Care 5, LLC
Keturah Kolett Hawk, RN
Amy Hawkins
Cameron Jewell Hawkins, PHARMACIST
Charteye Hawkins, APRN

All providers in Saint Petersburg, FL · Mental Health Counselor in Florida

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2010. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.