Active NPI
Tina Mathew
- Mental Health Counselor
- Coconut Creek, FL
National Provider Identifier
1710731922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- IMH24372
- Practice address
- 4825 NW 22ND St
Coconut Creek, FL 33063-3869 - Phone
- (954) 610-6382
- NPI assigned
- Apr 15, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | IMH24372 | FL | Primary |
Addresses
Primary practice location
4825 NW 22ND St
Coconut Creek, FL 33063-3869
Mailing address
2717 W Cypress Creek Rd
Fort Lauderdale, FL 33309-1703
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IMH24372 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713139200000",
"number": "1710731922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2717 W CYPRESS CREEK RD",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333091703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4825 NW 22ND ST",
"city": "COCONUT CREEK",
"state": "FL",
"postal_code": "330633869",
"telephone_number": "954-610-6382"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHEW",
"first_name": "TINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-04-15",
"last_updated": "2024-04-15",
"certification_date": "2024-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "IMH24372",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coconut Creek, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.