Healthcare Provider Details

I. General information

NPI: 1588285373
Provider Name (Legal Business Name): JENNIFER SANCHEZ PHD CRC CVE LP LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2020
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 NAVARRE RD
LAKE WORTH FL
33463-4634
US

IV. Provider business mailing address

4902 NAVARRE RD
LAKE WORTH FL
33463-4634
US

V. Phone/Fax

Practice location:
  • Phone: 608-622-5243
  • Fax:
Mailing address:
  • Phone: 608-622-5243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number097602
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number1077884
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00112743
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number097603
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: