Individual provider Active NPI

Sarah Smith

  • Mental Health Counselor
  • Lakeland, FL
National Provider Identifier
1457762551
Registry record updated Nov 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
IMH11175 Issued in FL
Practice address
715 N Lake Ave
Lakeland, FL 33801-1908
Phone
(863) 519-0575
NPI assigned
May 12, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X IMH11175 FL Primary

Addresses

Primary practice location

715 N Lake Ave
Lakeland, FL 33801-1908

Mailing address

PO Box 1559
Bartow, FL 33831-1559
Phone (863) 519-0575

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20240103000179 FL Practitioner - Mental Health Counselor 4587014592 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Peace River Center for Personal Development IncGroup PAC ID 7719877927, 29 clinicians

Practice addresses (Care Compare)

1835 Gilmore Ave
Lakeland, FL 33805-3017
Phone (863) 519-0575

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
IMH11175FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Peace River Center for Personal Development Inc CurrentSince Jan 1, 2024 Accepting new patients
Cotler Healthcare & Development Inc. CurrentSince Aug 18, 2024 Accepting new patients
Peace River Center for Personal Development Inc PastSince Apr 17, 2022 Accepting new patients

Locations

901 S 62nd Ave
Hollywood, FL 33023
Phone (954) 893-0109

9835 Lake Worth Rd
Ste 16179
Lake Worth, FL 33467

1831 Gilmore Ave
Lakeland, FL 33805
Phone 8635190575 ext. 6494

1825 Gilmore Ave
Lakeland, FL 33805
Phone (863) 248-3300

1835 Gilmore Ave
Lakeland, FL 33805
Phone (863) 248-3300

715 N Lake Ave
Lakeland, FL 33801
Phone (863) 413-2566

Organizations & group practices 3

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": "1399852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574208000000",
    "number": "1457762551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1559",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338311559",
            "telephone_number": "863-519-0575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 N LAKE AVE",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338011908",
            "telephone_number": "863-519-0575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SARAH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-12",
        "last_updated": "2019-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "IMH11175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

Verify at the official NPI Registry.