Active NPI
Lauren Pankuch, LMHC
- Mental Health Counselor
- Tampa, FL
National Provider Identifier
1881460459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH22958
- Practice address
- 550 N Reo St Ste 215
Tampa, FL 33609-1027 - Phone
- (813) 538-0385
- NPI assigned
- Nov 27, 2023
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MH22958 | FL | Primary |
Addresses
Primary practice location
550 N Reo St Ste 215
Tampa, FL 33609-1027
Mailing address
721 Wild Flower St
Merritt Island, FL 32953-8059
Phone (321) 749-7753
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH22958 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1701043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701043200000",
"number": "1881460459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "721 WILD FLOWER ST",
"city": "MERRITT ISLAND",
"state": "FL",
"postal_code": "329538059",
"telephone_number": "321-749-7753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 N REO ST STE 215",
"city": "TAMPA",
"state": "FL",
"postal_code": "336091027",
"telephone_number": "813-538-0385"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANKUCH",
"first_name": "LAUREN",
"credential": "LMHC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-11-27",
"last_updated": "2023-11-27",
"certification_date": "2023-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH22958",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.