Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jake Wallin

Individual provider Mental Health Counselor · NPI 1124604772

Jake Wallin is a Mental Health Counselor in Orlando, Florida. Qualified in 2020, 6 years ago. Practices with Diane M Kanous, a 6-clinician group, works from 2 locations and accepts Medicare assignment.

Years since qualifying
6
In the registry since
2021
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Practice location Address checks out

3612 Westland Dr
Orlando, FL 32818-2807
Phone: (407) 434-9792
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 6963 W Kl Ave Ste B, Kalamazoo, MI 49009-8043 — (269) 544-7720

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X

Record details

NPI number1124604772
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 23, 2021
Last updated in NPPESMarch 19, 2025
Certification dateMarch 19, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Diane M Kanous — 6 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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