Individual provider Active NPI

Stardust Myrtil, LMHC

  • Mental Health Counselor
  • West Palm Beach, FL
National Provider Identifier
1518502368
Registry record updated Aug 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH21692 Issued in FL
Practice address
4101 Parker Ave
West Palm Beach, FL 33405-2507
Phone
(561) 617-1222
NPI assigned
Nov 14, 2019
Last updated
Aug 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2023

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 MH21692 FL Primary

Addresses

Primary practice location

4101 Parker Ave
West Palm Beach, FL 33405-2507

Mailing address

4369 Woodstock Dr Apt D
West Palm Beach, FL 33409-2607
Phone (561) 541-7074

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
I20250111000019 FL Practitioner - Mental Health Counselor 2163950635 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Center for Family Services of Palm Beach County IncGroup PAC ID 8325100845, 2 clinicians

Practice addresses (Care Compare)

4101 Parker Ave
West Palm Beach, FL 33405-2507
Phone (561) 616-1222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Family Services of Palm Beach County Inc CurrentSince Jan 6, 2025 Accepting new patients

Locations

4101 Parker Ave
West Palm Beach, FL 33405
Phone (561) 616-1222

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1573689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692921600000",
    "number": "1518502368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4369 WOODSTOCK DR APT D",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334092607",
            "telephone_number": "561-541-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 PARKER AVE",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334052507",
            "telephone_number": "561-617-1222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYRTIL",
        "first_name": "STARDUST",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-14",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH21692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Palm Beach, FL

Sources for this page

Verify at the official NPI Registry.