Healthcare Provider Details

I. General information

NPI: 1407360324
Provider Name (Legal Business Name): JAMIE JIT LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 NEPTUNE RD
SAINT CLOUD FL
34769-6741
US

IV. Provider business mailing address

1844 GROVELINE RD
SAINT CLOUD FL
34771-8340
US

V. Phone/Fax

Practice location:
  • Phone: 407-593-6225
  • Fax:
Mailing address:
  • Phone: 270-215-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number263801
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number174979
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH25900
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: