NPIMap

Organization Active NPI

Santa Rosa Counseling Center LLC

  • Mental Health Counselor
  • Milton, FL
National Provider Identifier
1962697441
Registry record updated Aug 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
SANTA ROSA COUNSELING CENTER LLC
Practice address
5642 Jones St
Milton, FL 32570-2304
Phone
(850) 626-7779
Fax
(850) 626-7171
NPI assigned
Sep 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2022

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

Authorized official

Name
Karen Alesia Willis, LMFT, LMHCNPI 1518096247
Title
Senior Partner
Phone
(850) 626-7779

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X MH8971 FL
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Marriage & Family TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 106H00000X MT2297 FL

Addresses

Primary practice location

5642 Jones St
Milton, FL 32570-2304

Mailing address

5642 Jones St
Milton, FL 32570-2304
Phone (850) 626-7779

Other practice location 1

5441 Berryhill Rd
Milton, FL 32570-8026
Phone (850) 626-7779

Other identifiers 1

IdentifierTypeStateIssuer
103671100MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151014002147 FL Part B Supplier - Clinic/Group Practice 7012226061 Receives reassigned benefits from 13 practitioners
Practice locations: Milton, FL

National Provider Directory

National Provider Directory

Locations

5441 Berryhill Rd
Milton, FL 32570
Phone (850) 626-7779

5642 Jones St
Milton, FL 32570
Phone (850) 626-7779

Practitioners & affiliated clinicians

Practitioners 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660262400000",
    "number": "1962697441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5642 JONES ST",
            "city": "MILTON",
            "state": "FL",
            "postal_code": "325702304",
            "telephone_number": "850-626-7779",
            "fax_number": "850-626-7171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5642 JONES ST",
            "city": "MILTON",
            "state": "FL",
            "postal_code": "325702304",
            "telephone_number": "850-626-7779",
            "fax_number": "850-626-7171"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5441 Berryhill Rd",
            "address_purpose": "LOCATION",
            "city": "Milton",
            "state": "FL",
            "postal_code": "325708026",
            "country_code": "US",
            "telephone_number": "850-626-7779",
            "fax_number": "850-626-7171",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SANTA ROSA COUNSELING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-07",
        "last_updated": "2022-08-12",
        "certification_date": "2021-06-10",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "ALESIA",
        "authorized_official_title_or_position": "SENIOR PARTNER",
        "authorized_official_telephone_number": "850-626-7779",
        "authorized_official_credential": "LMFT, LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH8971",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "FL",
            "license": "MT2297",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103671100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; 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.