Healthcare Provider Details

I. General information

NPI: 1790256162
Provider Name (Legal Business Name): JEANNE ESGUERRA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 11/24/2023
Certification Date: 11/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N 6TH ST # 794
ST AUGUSTINE FL
32084-1920
US

IV. Provider business mailing address

2800 N 6TH ST # 794
ST AUGUSTINE FL
32084-1920
US

V. Phone/Fax

Practice location:
  • Phone: 904-990-6252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH15692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: