Active NPI
Kelly Janese Ballantine, LMHC
- Mental Health Counselor
- Lakeland, FL
National Provider Identifier
1649576596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH8819
- Practice address
- 1835 Gilmore Ave
Lakeland, FL 33805-3017 - Phone
- (863) 519-0575
- Fax
- (863) 582-9251
- NPI assigned
- Feb 9, 2011
- 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 | MH8819 | FL | Primary |
Addresses
Primary practice location
1835 Gilmore Ave
Lakeland, FL 33805-3017
Mailing address
PO Box 1559
Bartow, FL 33831-1559
Phone (863) 519-0575
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004724100 | 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 |
|---|---|---|---|
| MH8819 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1297209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434931200000",
"number": "1649576596",
"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",
"fax_number": "863-582-9251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1835 GILMORE AVE",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338053017",
"telephone_number": "863-519-0575",
"fax_number": "863-582-9251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALLANTINE",
"first_name": "KELLY",
"middle_name": "JANESE",
"credential": "LMHC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-02-09",
"last_updated": "2015-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH8819",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004724100",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lakeland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.