Pauleetta Lynn Whittaker, MS, LMHCA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH17090 Issued in FL

Practice address

4721 E Moody Blvd Ste 204
Bunnell, FL 32110-7706

Phone

(386) 793-9669

Fax

(386) 256-1761

NPI assigned

Sep 1, 2016

Last updated

Dec 7, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575676800000",
    "number": "1710433354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 8TH ST UNIT A",
            "city": "ST AUGUSTINE BEACH",
            "state": "FL",
            "postal_code": "320806351",
            "telephone_number": "317-443-5928",
            "fax_number": "386-256-1761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4721 E MOODY BLVD STE 204",
            "city": "BUNNELL",
            "state": "FL",
            "postal_code": "321107706",
            "telephone_number": "386-793-9669",
            "fax_number": "386-256-1761"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 San Sebastian Vw # 2102",
            "address_purpose": "LOCATION",
            "city": "St Augustine",
            "state": "FL",
            "postal_code": "320848695",
            "country_code": "US",
            "telephone_number": "317-443-5928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WHITTAKER",
        "first_name": "PAULEETTA",
        "middle_name": "LYNN",
        "credential": "MS, LMHCA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-01",
        "last_updated": "2019-12-07",
        "certification_date": "2019-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH17090",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201359450",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Bunnell, FL
• Providers in Bunnell, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2019; 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.