Kevin Eugene Fraley Jr. – Mental Health Counselor

Key facts

NPI: 1619679644
Entity type: Individual (NPI type 1)
Primary specialty: Mental Health Counselor 101YM0800X
License: MH21975 (FL)
Practice address: 4453 Highway 90
Pace, FL 32571-2066
Phone: (850) 905-0110
Fax: (850) 905-8600
NPI assigned: Mar 21, 2023
Sex: Male
Sole proprietor: No

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.

Partners Family Medicine Practice & Recovery Center Inc Addiction (Substance Use Disorder) Counselor · Pace, FL · NPI 1396364899

Medicare reassignment Care Compare group NPD FL

Medicare Care Compare profile

Specialty: Mental Health Counselor
Education: Other, 2017
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Partners Family Medicine Practice and Recovery Center Inc (3 clinicians)

Practice addresses (Care Compare)

4453 Hwy 90
Pace, FL 32571-2066
Phone 85090501102

Medicare participation

Medicare fee-for-service enrollment: Enrolled in FL
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20250331001945	FL	Practitioner - Mental Health Counselor	5799208757	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
MH21975	FL	MD	Mental Health Counselor

Practice roles

Organization	Specialty	Status	New patients
Partners Family Medicine Practice & Recovery Center Inc		Current since Jan 25, 2025	Accepting new patients

Locations

4453 Highway 90
Pace, FL 32571
Phone (850) 905-0110

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Mental Health Counselor	101YM0800X	MH21975	FL	Yes

Addresses

Primary practice location

4453 Highway 90
Pace, FL 32571-2066

Mailing address

4453 Highway 90
Pace, FL 32571-2066
Phone (850) 905-0110

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 21, 2023.

{
    "created_epoch": "1679356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679356800000",
    "number": "1619679644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4453 HIGHWAY 90",
            "city": "PACE",
            "state": "FL",
            "postal_code": "325712066",
            "telephone_number": "850-905-0110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4453 HIGHWAY 90",
            "city": "PACE",
            "state": "FL",
            "postal_code": "325712066",
            "telephone_number": "850-905-0110",
            "fax_number": "850-905-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRALEY",
        "first_name": "KEVIN",
        "middle_name": "EUGENE",
        "name_suffix": "Jr.",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-21",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH21975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pace, FL

All providers in Pace, FL · Mental Health Counselor in Florida

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 21, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.