Healthcare Provider Details

I. General information

NPI: 1487245965
Provider Name (Legal Business Name): JENNIFER CUNNINGHAM LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER CUNNINGHAM

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 2ND ST N FL USA 2ND
SAINT PETERSBURG FL
33701-3328
US

IV. Provider business mailing address

8035 17TH ST N
ST PETERSBURG FL
33702-3951
US

V. Phone/Fax

Practice location:
  • Phone: 727-300-1861
  • Fax:
Mailing address:
  • Phone: 248-417-1553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18615
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: