Individual provider Active NPI

Jacqueline A Heiny

  • Mental Health Counselor
  • Lake Mary, FL
National Provider Identifier
1700983178
Registry record updated Feb 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
310 Waymont CT Ste 100
Lake Mary, FL 32746-3475
Phone
(407) 416-3840
NPI assigned
Sep 20, 2006
Last updated
Feb 13, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 13, 2025

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 NU Primary

Addresses

Primary practice location

310 Waymont CT Ste 100
Lake Mary, FL 32746-3475

Mailing address

536 Bottlebrush Loop
Sanford, FL 32771-0037
Phone (407) 732-4817

Other practice location 1

354 Englenook Dr
Debary, FL 32713-1804
Phone (386) 518-2590

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
I20231220001464 FL Practitioner - Mental Health Counselor 5890145627 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

310 Waymont CT
Suite 100
Lake Mary, FL 32746-3475
Phone (407) 635-1979

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Mary Counseling Mental Health CurrentSince Jan 1, 2024 Accepting new patients
LMC Debary LLC Mental Health PastSince Jan 1, 2024 Accepting new patients

Locations

354 Englenook Dr
Debary, FL 32713
Phone (386) 518-2590

310 Waymont Ct
Ste 100
Lake Mary, FL 32746
Phone (407) 416-3840

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739404800000",
    "number": "1700983178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "536 BOTTLEBRUSH LOOP",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327710037",
            "telephone_number": "407-732-4817",
            "fax_number": "407-732-4817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 WAYMONT CT STE 100",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463475",
            "telephone_number": "407-416-3840"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "354 Englenook Dr",
            "address_purpose": "LOCATION",
            "city": "Debary",
            "state": "FL",
            "postal_code": "327131804",
            "country_code": "US",
            "telephone_number": "386-518-2590",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HEINY",
        "first_name": "JACQUELINE",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

Verify at the official NPI Registry.