Active NPI
Michelle L Gwaltney, LICENSED PASTORAL CO
- Pastoral Counselor
- Punta Gorda, FL
National Provider Identifier
1790505964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pastoral Counselor
- License
- 22374
- Practice address
- 265 E Marion Ave Unit 117a
Punta Gorda, FL 33950-3715 - Phone
- (404) 938-1469
- NPI assigned
- Oct 14, 2024
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pastoral Counselor | 101YP1600X | 22374 | FL | Primary |
Addresses
Primary practice location
265 E Marion Ave Unit 117a
Punta Gorda, FL 33950-3715
Mailing address
265 E Marion Ave Unit 117a
Punta Gorda, FL 33950-3715
Phone (404) 938-1469
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 |
|---|---|---|---|
| 22374 | FL | MD | Pastoral Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728864000000",
"number": "1790505964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "265 E MARION AVE UNIT 117A",
"city": "PUNTA GORDA",
"state": "FL",
"postal_code": "339503715",
"telephone_number": "404-938-1469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "265 E MARION AVE UNIT 117A",
"city": "PUNTA GORDA",
"state": "FL",
"postal_code": "339503715",
"telephone_number": "404-938-1469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GWALTNEY",
"first_name": "MICHELLE",
"middle_name": "L",
"credential": "LICENSED PASTORAL CO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-10-14",
"last_updated": "2024-10-14",
"certification_date": "2024-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YP1600X",
"taxonomy_group": "",
"desc": "Counselor, Pastoral",
"state": "FL",
"license": "22374",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Punta Gorda, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 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.