Healthcare Provider Details

I. General information

NPI: 1407525488
Provider Name (Legal Business Name): JESSICA OHARA MFTRI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 PINE AVE N
OLDSMAR FL
34677-4629
US

IV. Provider business mailing address

14523 WEEPING ELM DR
TAMPA FL
33626-3036
US

V. Phone/Fax

Practice location:
  • Phone: 813-343-0436
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT3693
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: