Individual provider Active NPI

Cynthia Dianne Roberts, LMHC

  • Mental Health Counselor
  • Palm Coast, FL
National Provider Identifier
1437276912
Registry record updated Jul 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH12217 Issued in FL
Practice address
160 Cypress Point Pkwy
Palm Coast, FL 32164-8433
Phone
(386) 585-4645
Fax
(386) 276-3474
NPI assigned
Mar 22, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X MH12217 FL Primary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X C8241 OR

Addresses

Primary practice location

160 Cypress Point Pkwy
Palm Coast, FL 32164-8433

Mailing address

285 Summit View Ave SE
Salem, OR 97306-8609
Phone (386) 451-0684

Other identifiers 2

IdentifierTypeStateIssuer
MH12217OtherFLSTATE LICENSE
C8241OtherORLICENSE

Other names 1

  • Cynthia Dianne Hairston Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, FL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250619001704 OR Practitioner - Mental Health Counselor 9234640897 Reassigns benefits to 1 organization
Practice locations: Salem, OR
I20260321000315 FL Practitioner - Mental Health Counselor 9234640897 Reassigns benefits to 1 organization
Practice locations: Jacksonville, FL

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grow Healthcare Group PAGroup PAC ID 3476961368, 1,045 clinicians

Practice addresses (Care Compare)

66 E Flagler St
Miami, FL 33130-1807
Phone (786) 244-7711

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MH12217FLMDMental Health Counselor

Organizations & group practices 1

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": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1437276912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 SUMMIT VIEW AVE SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973068609",
            "telephone_number": "386-451-0684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 CYPRESS POINT PKWY",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321648433",
            "telephone_number": "386-585-4645",
            "fax_number": "386-276-3474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "CYNTHIA",
        "middle_name": "DIANNE",
        "name_prefix": "Mrs.",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-22",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH12217",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C8241",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "MH12217",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "C8241",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CYNTHIA",
            "last_name": "HAIRSTON",
            "middle_name": "DIANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Palm Coast, FL

Sources for this page

Verify at the official NPI Registry.