Individual provider Active NPI

Victoria Jiencke, LMHC

  • Mental Health Counselor
  • St Petersburg, FL
National Provider Identifier
1669755013
Registry record updated Sep 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH10363 Issued in FL
Practice address
4024 Central Ave
St Petersburg, FL 33711-1239
Phone
(727) 327-7656
NPI assigned
Sep 22, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 22, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X MH10363 FL Primary

Addresses

Primary practice location

4024 Central Ave
St Petersburg, FL 33711-1239

Mailing address

4024 Central Ave
St Petersburg, FL 33711-1239
Phone (727) 327-7656

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240925000021 FL Practitioner - Mental Health Counselor 4183165699 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centerstone of Florida IncGroup PAC ID 2668468596, 35 clinicians

Practice addresses (Care Compare)

2901 Fruitville Rd
Sarasota, FL 34237-5320
Phone (941) 782-4150

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MH10363FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Centerstone of Florida, Inc. CurrentSince Jul 19, 2024 Accepting new patients

Locations

2020 26th Ave E
Bradenton, FL 34208
Phone (941) 782-4600

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.

NPI Registry JSON

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

{
    "created_epoch": "1316649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316649600000",
    "number": "1669755013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4024 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337111239",
            "telephone_number": "727-327-7656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4024 CENTRAL AVE",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337111239",
            "telephone_number": "727-327-7656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIENCKE",
        "first_name": "VICTORIA",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-22",
        "last_updated": "2011-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH10363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.