Individual provider Active NPI

Melissa Sue Van Keuren, MA

  • Mental Health Counselor
  • Titusville, FL
National Provider Identifier
1790382935
Registry record updated Jul 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
IMH16613 Issued in FL
Practice address
705 Harrison St
Titusville, FL 32780-4913
Phone
(321) 451-2851
NPI assigned
Oct 1, 2020
Last updated
Jul 15, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 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 IMH16613 FL Primary

Addresses

Primary practice location

705 Harrison St
Titusville, FL 32780-4913

Mailing address

2930 Elmwood CT
Titusville, FL 32780-5157
Phone (321) 848-4776

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20231218003237 FL Practitioner - Mental Health Counselor 2769831643 Reassigns benefits to 1 organization
I20240716001520 GA Practitioner - Mental Health Counselor 2769831643 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
IMH16613FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
MCCD FL Psychiatry Services PA CurrentSince Jan 1, 2024 Accepting new patients

Locations

1301 Riverplace Blvd
Jacksonville, FL 32207

300 Colonial Center Pkwy
Ofc 12
Roswell, GA 30076
Phone (833) 351-1825

10 Glenlake Pkwy
Ste 130
Sandy Springs, GA 30328
Phone (678) 230-7095

109 W 27th St
Rm 5S
New York, NY 10001
Phone (332) 230-4572

Organizations & group practices 1

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": "1601510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752537600000",
    "number": "1790382935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2930 ELMWOOD CT",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327805157",
            "telephone_number": "321-848-4776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 HARRISON ST",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327804913",
            "telephone_number": "321-451-2851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN KEUREN",
        "first_name": "MELISSA",
        "middle_name": "SUE",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-01",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "IMH16613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Titusville, FL

Sources for this page

Verify at the official NPI Registry.