NPIMap

Organization Active NPI

Village Counseling Center of Gainesville, Inc.

Doing business as Village Counseling Center

  • Mental Health Counselor
  • Gainesville, FL
National Provider Identifier
1407306897
Registry record updated Oct 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH4473 Issued in FL
Legal business name
VILLAGE COUNSELING CENTER OF GAINESVILLE, INC.
Doing business as
Village Counseling Center
Practice address
3919 W Newberry Road
Suite 5
Gainesville, FL 32607-4848
Phone
(352) 373-8189
Fax
(352) 373-8190
NPI assigned
Oct 10, 2016
Last updated
Oct 10, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2016

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

Authorized official

Name
Mr. Robert Dylan Edelman, ED.S., LMHC
Title
President/Ceo
Phone
(352) 373-8189

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X MH4473 FL Primary

Addresses

Primary practice location

3919 W Newberry Road
Suite 5
Gainesville, FL 32607-4848

Mailing address

3919 W Newberry Rd
Suite 5
Gainesville, FL 32607-4828
Phone (352) 373-8189

Other identifiers 1

IdentifierTypeStateIssuer
766664100MedicaidFL

Other names 1

  • Village Counseling Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Village Counseling Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3919 Newberry Rd
Ste 5
Gainesville, FL 32607
Phone (352) 373-8189

Practitioners & affiliated clinicians

Practitioners 3

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": "1476057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476057600000",
    "number": "1407306897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3919 W NEWBERRY RD",
            "address_2": "SUITE 5",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326074828",
            "telephone_number": "352-373-8189",
            "fax_number": "352-373-8190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3919 W NEWBERRY ROAD",
            "address_2": "SUITE 5",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326074848",
            "telephone_number": "352-373-8189",
            "fax_number": "352-373-8190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE COUNSELING CENTER OF GAINESVILLE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-10",
        "last_updated": "2016-10-10",
        "status": "A",
        "authorized_official_last_name": "EDELMAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "DYLAN",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "352-373-8189",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ED.S., LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH4473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "766664100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Village Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gainesville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; 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.