NPIMap

Organization Active NPI

Tim Green LMHC LLC

  • Mental Health Counselor
  • Estero, FL
National Provider Identifier
1336679950
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH7986 Issued in FL
Legal business name
TIM GREEN LMHC LLC
Practice address
9500 Corkscrew Palms Cir Ste 3
Estero, FL 33928
Phone
(239) 321-0797
Fax
(239) 390-0241
NPI assigned
Jun 15, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Tim Green, LMHCNPI 1689780603
Title
Owner
Phone
(239) 321-0797

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
Mental Health Counselor 101YM0800X MH7986 FL Primary

Addresses

Primary practice location

9500 Corkscrew Palms Cir Ste 3
Estero, FL 33928

Mailing address

229 Ambury St
Fort Myers, FL 33913-7131
Phone (239) 321-0797

Other practice location 1

12431 Brantley Commons Court
Suite 101
Ft Myers, FL 33907
Phone (239) 321-0797

Other practice location 2

12431 Brantley Commons Court
Suite 101
Ft Myers, FL 33907
Phone (239) 321-0797

Other identifiers 1

IdentifierTypeStateIssuer
1689780603OtherNPI

National Provider Directory

National Provider Directory

Locations

9500 Corkscrew Palms Cir
Ste 3
Estero, FL 33928
Phone (239) 948-7555

12431 Brantley Commons Ct
Ste 101
Fort Myers, FL 33907
Phone (239) 275-6001

Practitioners & affiliated clinicians

Practitioners 2

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": "1497484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1336679950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 AMBURY ST",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339137131",
            "telephone_number": "239-321-0797",
            "fax_number": "239-390-0241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 CORKSCREW PALMS CIR STE 3",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "33928",
            "telephone_number": "239-321-0797",
            "fax_number": "239-390-0241"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12431 Brantley Commons Court",
            "address_2": "Suite 101",
            "address_purpose": "LOCATION",
            "city": "Ft Myers",
            "state": "FL",
            "postal_code": "33907",
            "country_code": "US",
            "telephone_number": "239-321-0797",
            "fax_number": "239-275-6160",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12431 Brantley Commons Court",
            "address_2": "Suite 101",
            "address_purpose": "LOCATION",
            "city": "Ft Myers",
            "state": "FL",
            "postal_code": "33907",
            "country_code": "US",
            "telephone_number": "239-321-0797",
            "fax_number": "239-275-6160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TIM GREEN LMHC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-15",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "239-321-0797",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH7986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1689780603",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Estero, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.