Active NPI
Gwendolyn Green
- Mental Health Counselor
- Tampa, FL
National Provider Identifier
1588060651
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH10951
- Practice address
- 5109 N Nebraska Ave
Tampa, FL 33603-2301 - Phone
- (813) 238-8557
- Fax
- (813) 232-2009
- NPI assigned
- Nov 17, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MH10951 | FL | Primary |
Addresses
Primary practice location
5109 N Nebraska Ave
Tampa, FL 33603-2301
Mailing address
18135 Bahama Bay Dr
Tampa, FL 33647-3459
Phone (813) 482-8197
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700282969 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH10951 | FL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tampa Crossroads | Current | Accepting new patients | |
| Tampa Crossroads, Inc | Current | Accepting new patients |
Locations
5109 N Nebraska Ave
Tampa, FL 33603
Phone (813) 238-8557
Organizations & group practices 2
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.
-
- Community/Behavioral Health Agency
- Tampa, FL
- NPI 1700282969
-
- Mental Illness Community Based Residential Treatment Facility
- St Petersburg, FL
- NPI 1801922869
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416182400000",
"number": "1588060651",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18135 BAHAMA BAY DR",
"city": "TAMPA",
"state": "FL",
"postal_code": "336473459",
"telephone_number": "813-482-8197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5109 N NEBRASKA AVE",
"city": "TAMPA",
"state": "FL",
"postal_code": "336032301",
"telephone_number": "813-238-8557",
"fax_number": "813-232-2009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "GWENDOLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-11-17",
"last_updated": "2014-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH10951",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1700282969",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.