Individual provider Active NPI

Christopher Ronald Kizirian, RMHCI

  • Mental Health Counselor
  • Bartow, FL
National Provider Identifier
1790308617
Registry record updated Dec 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
IMH19895 Issued in FL
Practice address
1255 Golfview Ave
Bartow, FL 33830-6736
Phone
(863) 519-0575
Fax
(863) 582-9251
NPI assigned
May 27, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2020

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 IMH19895 FL Primary

Addresses

Primary practice location

1255 Golfview Ave
Bartow, FL 33830-6736

Mailing address

PO Box 1559
Bartow, FL 33831-1559
Phone (863) 519-0575

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
I20240108003651 FL Practitioner - Mental Health Counselor 4880045533 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Peace River Center for Personal Development IncGroup PAC ID 7719877927, 29 clinicians

Practice addresses (Care Compare)

1835 Gilmore Ave
Lakeland, FL 33805-3017
Phone (863) 519-0575

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
IMH19895FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Peace River Center for Personal Development Inc CurrentSince Jan 1, 2024 Accepting new patients
Peace River Center for Personal Development Inc PastSince Apr 17, 2022 Accepting new patients

Locations

1255 Golfview Ave
Bartow, FL 33830
Phone 8635190575 ext. 6494

1825 Gilmore Ave
Lakeland, FL 33805
Phone (863) 248-3300

1835 Gilmore Ave
Lakeland, FL 33805
Phone (863) 248-3300

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1590537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607904000000",
    "number": "1790308617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1559",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338311559",
            "telephone_number": "863-519-0575",
            "fax_number": "863-582-9251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 GOLFVIEW AVE",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338306736",
            "telephone_number": "863-519-0575",
            "fax_number": "863-582-9251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIZIRIAN",
        "first_name": "CHRISTOPHER",
        "middle_name": "RONALD",
        "credential": "RMHCI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-27",
        "last_updated": "2020-12-14",
        "certification_date": "2020-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "IMH19895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bartow, FL

Sources for this page

Verify at the official NPI Registry.