Healthcare Provider Details

I. General information

NPI: 1801260484
Provider Name (Legal Business Name): JEENA SUZET SANCHEZ FRIAS IMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6447 S CHICKASAW TRL
ORLANDO FL
32829-8366
US

IV. Provider business mailing address

6447 S CHICKASAW TRL
ORLANDO FL
32829-8366
US

V. Phone/Fax

Practice location:
  • Phone: 407-249-1234
  • Fax:
Mailing address:
  • Phone: 407-249-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberIMH29247
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH29247
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: