Healthcare Provider Details

I. General information

NPI: 1811801178
Provider Name (Legal Business Name): JENNY BOSS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 VARIETY TREE CIR
ALTAMONTE SPRINGS FL
32714-5834
US

IV. Provider business mailing address

129 VARIETY TREE CIR
ALTAMONTE SPRINGS FL
32714-5834
US

V. Phone/Fax

Practice location:
  • Phone: 689-308-8856
  • Fax:
Mailing address:
  • Phone: 689-308-8856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENNY BOSS
Title or Position: OWNER/COUNSELOR
Credential: RMHCI
Phone: 689-308-8856