Healthcare Provider Details

I. General information

NPI: 1164336103
Provider Name (Legal Business Name): JENNY M CAMPOS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 BISCAYNE BLVD FL 5
MIAMI FL
33137-4130
US

IV. Provider business mailing address

5520 SW 4TH ST
CORAL GABLES FL
33134-1025
US

V. Phone/Fax

Practice location:
  • Phone: 305-576-6611
  • Fax:
Mailing address:
  • Phone: 305-576-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH28315
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: