Healthcare Provider Details

I. General information

NPI: 1336734375
Provider Name (Legal Business Name): JENELLE ASHLEY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 W UNIVERSITY AVE # 205C
GAINESVILLE FL
32601-3248
US

IV. Provider business mailing address

6820 NW 57TH WAY
GAINESVILLE FL
32653-3209
US

V. Phone/Fax

Practice location:
  • Phone: 352-310-8470
  • Fax:
Mailing address:
  • Phone: 352-310-8470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18768
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: