Active NPI
Ian Jonas Keene Gerhard, LMHC
- Mental Health Counselor
- Wimauma, FL
National Provider Identifier
1629642145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH19065
- Practice address
- 10763 Standing Stone Dr
Wimauma, FL 33598-6164 - Phone
- (813) 758-2642
- NPI assigned
- May 19, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 | MH19065 | FL | Primary |
Addresses
Primary practice location
10763 Standing Stone Dr
Wimauma, FL 33598-6164
Mailing address
10763 Standing Stone Dr
Wimauma, FL 33598-6164
Phone (813) 758-2642
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 |
|---|---|---|---|
| MH19065 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621382400000",
"number": "1629642145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10763 STANDING STONE DR",
"city": "WIMAUMA",
"state": "FL",
"postal_code": "335986164",
"telephone_number": "813-758-2642"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10763 STANDING STONE DR",
"city": "WIMAUMA",
"state": "FL",
"postal_code": "335986164",
"telephone_number": "813-758-2642"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GERHARD",
"first_name": "IAN",
"middle_name": "JONAS KEENE",
"credential": "LMHC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-05-19",
"last_updated": "2021-05-19",
"certification_date": "2021-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH19065",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wimauma, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.