Healthcare Provider Details

I. General information

NPI: 1922618206
Provider Name (Legal Business Name): JENNIFER STEVENS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 W SAMPLE RD STE 1A
POMPANO BEACH FL
33073-3081
US

IV. Provider business mailing address

380 W PALMETTO PARK RD UNIT 111
BOCA RATON FL
33432-6713
US

V. Phone/Fax

Practice location:
  • Phone: 305-310-6558
  • Fax:
Mailing address:
  • Phone: 305-310-6558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH8086
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH8086
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: