Providencepass, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

PROVIDENCEPASS, LLC

Practice address

741 Front St Ste 210
Kissimmee, FL 34747-4992

Phone

(844) 244-2840

NPI assigned

May 29, 2019

Organization subpart

No

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

Authorized official

Name

Jennifer Del Giudice

Title

Executive Director

Phone

(844) 244-2840

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Donta Walker

  • Case Manager/Care Coordinator
  • Jacksonville, FL
  • NPI 1659039337
  NPD (past)

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

{
    "created_epoch": "1559088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559088000000",
    "number": "1811554546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "741 FRONT ST STE 210",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347474992",
            "telephone_number": "844-244-2840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 FRONT ST STE 210",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347474992",
            "telephone_number": "844-244-2840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCEPASS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-29",
        "last_updated": "2019-05-29",
        "status": "A",
        "authorized_official_last_name": "DEL GIUDICE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "844-244-2840"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jennifer@providencepass.com",
            "affiliation": "N",
            "address_1": "741 Front St Ste 210",
            "city": "Kissimmee",
            "state": "FL",
            "country_code": "US",
            "postal_code": "347474992",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Counselor in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 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.