NPIMap

Organization Active NPI

Jean Gautreaux LLC

  • Clinical Social Worker
  • Palm Bay, FL
National Provider Identifier
1336788363
Registry record updated Mar 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
JEAN GAUTREAUX LLC
Practice address
4630 Lipscomb St NE Ste 1a
Palm Bay, FL 32905-2940
Phone
(321) 405-2583
NPI assigned
Dec 20, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2022

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

Authorized official

Name
Jean Gautreaux, LCSW
Title
Owner
Phone
(321) 405-2583

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

4630 Lipscomb St NE Ste 1a
Palm Bay, FL 32905-2940

Mailing address

2257 Whiteside Ave SE
Palm Bay, FL 32909-6044
Phone (321) 405-2583

Other names 1

  • Limitless Growth Counseling Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200421000749 FL Part B Supplier - Clinic/Group Practice 1951731645 Practice locations: Palm Bay, FL

National Provider Directory

National Provider Directory

Locations

2475 Palm Bay Rd NE
Ste 130
Palm Bay, FL 32905
Phone (321) 222-0039

4630 Lipscomb St NE
Ste 1A
Palm Bay, FL 32905
Phone (321) 405-2583

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1576800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646697600000",
    "number": "1336788363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2257 WHITESIDE AVE SE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329096044",
            "telephone_number": "321-405-2583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4630 LIPSCOMB ST NE STE 1A",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329052940",
            "telephone_number": "321-405-2583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEAN GAUTREAUX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-20",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A",
        "authorized_official_last_name": "GAUTREAUX",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-405-2583",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Limitless Growth Counseling",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Limitless Growth Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palm Bay, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.