Healthcare Provider Details

I. General information

NPI: 1275746000
Provider Name (Legal Business Name): JANE MCDANIEL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 FERNWOOD BLVD
FERN PARK FL
32730-2116
US

IV. Provider business mailing address

25008 THORNHILL DR
SORRENTO FL
32776-9036
US

V. Phone/Fax

Practice location:
  • Phone: 407-323-2036
  • Fax: 407-324-0195
Mailing address:
  • Phone: 352-383-4643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH7360
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: