NPIMap

Organization Active NPI

Bayou Wellness of Northwest Florida, LLC

  • Counselor
  • Pensacola, FL
National Provider Identifier
1841778636
Registry record updated Dec 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
MH12035 Issued in FL
Legal business name
BAYOU WELLNESS OF NORTHWEST FLORIDA, LLC
Practice address
17 W Maxwell St
Pensacola, FL 32501-1717
Phone
(850) 324-7912
Fax
(850) 270-7821
NPI assigned
Aug 2, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2023

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

Authorized official

Name
Andrea Burks, LMHCNPI 1093142739
Title
Counselor, Owner
Phone
(850) 324-7912

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101Y00000X MH12035 FL Primary

Addresses

Primary practice location

17 W Maxwell St
Pensacola, FL 32501-1717

Mailing address

17 W Maxwell St
Pensacola, FL 32501-1717
Phone (850) 324-7912

Other names 1

  • Bayou Wellness Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200601001461 FL Part B Supplier - Clinic/Group Practice 4587085444 Receives reassigned benefits from 8 practitioners
Practice locations: Pensacola, FL

National Provider Directory

National Provider Directory

Locations

69 Bay Bridge Dr
Ste G
Gulf Breeze, FL 32561
Phone (850) 324-7912

7100 Plantation Rd
Ste 2
Pensacola, FL 32504
Phone (850) 324-7912

17 W Maxwell St
Pensacola, FL 32501
Phone (850) 324-7912

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1533168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701388800000",
    "number": "1841778636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 W MAXWELL ST",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325011717",
            "telephone_number": "850-324-7912",
            "fax_number": "850-270-7821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 W MAXWELL ST",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325011717",
            "telephone_number": "850-324-7912",
            "fax_number": "850-270-7821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYOU WELLNESS OF NORTHWEST FLORIDA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-02",
        "last_updated": "2023-12-01",
        "certification_date": "2023-12-01",
        "status": "A",
        "authorized_official_last_name": "BURKS",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "COUNSELOR, OWNER",
        "authorized_official_telephone_number": "850-324-7912",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor",
            "state": "FL",
            "license": "MH12035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bayou Wellness",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pensacola, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.