Healthcare Provider Details

I. General information

NPI: 1316130461
Provider Name (Legal Business Name): JENNIFER FAWN LAMBO COOMES LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7655 W GULF TO LAKE HWY STE 15
CRYSTAL RIVER FL
34429-7910
US

IV. Provider business mailing address

7655 W GULF TO LAKE HWY STE 11
CRYSTAL RIVER FL
34429-7910
US

V. Phone/Fax

Practice location:
  • Phone: 352-423-3127
  • Fax:
Mailing address:
  • Phone: 352-423-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH19669
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: