Cletus Leon Deller, LMHC INTERN

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH10772 Issued in FL

Practice address

96173 Piney Island Dr
Fernandina Beach, FL 32034-0858

Phone

(772) 321-3306

NPI assigned

Feb 18, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1297987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309824000000",
    "number": "1912204470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96173 PINEY ISLAND DR",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320340858",
            "telephone_number": "772-321-3306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96173 PINEY ISLAND DR",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320340858",
            "telephone_number": "772-321-3306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELLER",
        "first_name": "CLETUS",
        "middle_name": "LEON",
        "name_prefix": "Mr.",
        "credential": "LMHC INTERN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-02-18",
        "last_updated": "2011-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH10772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH LICENSE",
            "identifier": "MH10772",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Cwikla, OD
• David Daugherty, RMFTI
• Wendy A De Santo, PT
• Shanin Leah Degraw, PTA
• Summer Suzanne Delille, R.D.H.
• Margeaux Jenee Dennis, DO
• Stephanie Desilet, MS, CCC-SLP
• Philip Todd Devane, M.D.
• Diana R Twiggs MD
• Benjamin Nolan Diller, D.D.S.

• Mental Health Counselor in Fernandina Beach, FL
• Providers in Fernandina Beach, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2011; 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.