Individual provider Active NPI

John Wigmore Reilly IV

  • Mental Health Counselor
  • Winter Park, FL
National Provider Identifier
1700737863
Registry record updated Feb 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
2479 Aloma Ave
Winter Park, FL 32792-2541
Phone
(407) 657-6692
NPI assigned
Feb 5, 2026
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 5, 2026

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 FL Primary

Addresses

Primary practice location

2479 Aloma Ave
Winter Park, FL 32792-2541

Mailing address

1851 Lpga Blvd Apt 11301
Daytona Beach, FL 32117-7192
Phone (407) 534-9317

Other practice location 1

2300 Lee Rd
Winter Park, FL 32789-1750
Phone (407) 960-3938

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

NPI Registry JSON

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

{
    "created_epoch": "1770249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770249600000",
    "number": "1700737863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1851 LPGA BLVD APT 11301",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321177192",
            "telephone_number": "407-534-9317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2479 ALOMA AVE",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327922541",
            "telephone_number": "407-657-6692"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2300 Lee Rd",
            "address_purpose": "LOCATION",
            "city": "Winter Park",
            "state": "FL",
            "postal_code": "327891750",
            "country_code": "US",
            "telephone_number": "407-960-3938",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REILLY",
        "first_name": "JOHN",
        "middle_name": "WIGMORE",
        "name_prefix": "Mr.",
        "name_suffix": "IV",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2026-02-05",
        "last_updated": "2026-02-05",
        "certification_date": "2026-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.