Healthcare Provider Details

I. General information

NPI: 1710698683
Provider Name (Legal Business Name): JENNIFER FARRELL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 OAKFIELD DR
BRANDON FL
33511-5714
US

IV. Provider business mailing address

615 OAKFIELD DR
BRANDON FL
33511-5714
US

V. Phone/Fax

Practice location:
  • Phone: 833-769-3524
  • Fax: 813-200-9860
Mailing address:
  • Phone: 833-769-3524
  • Fax: 813-200-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT4441
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: