Healthcare Provider Details

I. General information

NPI: 1063317931
Provider Name (Legal Business Name): CRISTINA YOLANDA JARA RIVERA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2026
Last Update Date: 11/03/2026
Certification Date: 11/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11722 MOONSAIL DR
PARRISH FL
34219-1860
US

IV. Provider business mailing address

11722 MOONSAIL DR
PARRISH FL
34219-1860
US

V. Phone/Fax

Practice location:
  • Phone: 813-819-1012
  • Fax:
Mailing address:
  • Phone: 813-819-1012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH29002
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: