MEDICARE: JENNY BATALLA LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	IMH19157	FL
2	101YM0800X	Mental Health Counselor	MH21605	FL

General Provider Information

NPI Number	:	1851926216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY BATALLA LMHC

Provider Business Mailing Address
First Line	:	1015 ATLANTIC BLVD # 103
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-3313
Country	:	US
Telephone Number	:	904-780-0207
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 MARSH LANDING BLVD STE 203
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-1287
Country	:	US
Telephone Number	:	904-780-0207
Fax Number	:	941-761-6353

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2020
Last Update Date	:	01/08/2025

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