Healthcare Provider Details

I. General information

NPI: 1851609697
Provider Name (Legal Business Name): JENNIFER LYNN SCHANZENBACH M.A., L.M.H.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 1ST AVE NORTH
ST. PETERSBURG FL
33701-3802
US

IV. Provider business mailing address

9365 CRESTVIEW ST
SEMINOLE FL
33772-3041
US

V. Phone/Fax

Practice location:
  • Phone: 727-430-7885
  • Fax:
Mailing address:
  • Phone: 727-430-7885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 12903
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: