Spruce Creek Mental Health Services, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW10520 Issued in FL

Legal business name

SPRUCE CREEK MENTAL HEALTH SERVICES, LLC

Practice address

1690 Dunlawton Ave
Suite 125
Port Orange, FL 32127-8979

Phone

(386) 681-8639

Fax

(386) 310-3992

NPI assigned

Jan 17, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Edward C King, LCSWNPI 1659623213

Title

Owner

Phone

(386) 681-8639

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edward Cecil King, LCSW

  • Mental Health Counselor
  • Port Orange, FL
  • NPI 1659623213

  Clinical

  NPD (past) Authorized official
• Lauren Silver, M.S.

  • Mental Health Counselor
  • Port Orange, FL
  • NPI 1811354525
  NPD (past)

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

{
    "created_epoch": "1358380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359676800000",
    "number": "1669710273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6112 PALMAS DR",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321276751",
            "telephone_number": "386-681-8639",
            "fax_number": "386-310-3992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 DUNLAWTON AVE",
            "address_2": "SUITE 125",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321278979",
            "telephone_number": "386-681-8639",
            "fax_number": "386-310-3992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRUCE CREEK MENTAL HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-17",
        "last_updated": "2013-02-01",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-681-8639",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW10520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sovereign Healthcare of Port Orange, LLC
• Space Coast Spine LLC.
• Deanna Kingsley Springer, M.D.
• Spruce Creek Counseling, LLC
• Spruce Creek Family Care
• Spruce Dental, LLC
• Anunporn Srisawat, M.D.
• Shannon St Amant, D.C.
• Lisa St. Louis, PHARMD
• Stacy O'Brien Audiology

• Clinical Social Worker in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.