Active NPI
Rusty Black
- Mental Health Counselor
- Gulf Breeze, FL
National Provider Identifier
1871432690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 27272
- Practice address
- 350 Pensacola Beach Rd
Gulf Breeze, FL 32561-4815 - Phone
- (833) 551-2304
- NPI assigned
- Mar 26, 2026
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 27272 | FL | Primary |
Addresses
Primary practice location
350 Pensacola Beach Rd
Gulf Breeze, FL 32561-4815
Mailing address
350 Pensacola Beach Rd
Gulf Breeze, FL 32561-4815
Phone (833) 551-2304
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 |
|---|---|---|---|
| 27272 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1774483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774483200000",
"number": "1871432690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 PENSACOLA BEACH RD",
"city": "GULF BREEZE",
"state": "FL",
"postal_code": "325614815",
"telephone_number": "833-551-2304"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 PENSACOLA BEACH RD",
"city": "GULF BREEZE",
"state": "FL",
"postal_code": "325614815",
"telephone_number": "833-551-2304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "RUSTY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-03-26",
"last_updated": "2026-03-26",
"certification_date": "2026-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "27272",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gulf Breeze, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.