Healthcare Provider Details

I. General information

NPI: 1942063284
Provider Name (Legal Business Name): JENNIFER BOOKER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12451 GINGER TREE ST UNIT 112
TAMPA FL
33637-1963
US

IV. Provider business mailing address

14710 VIA ESTRELLA PL
TAMPA FL
33626-1661
US

V. Phone/Fax

Practice location:
  • Phone: 813-505-5552
  • Fax:
Mailing address:
  • Phone: 813-616-2846
  • Fax: 813-804-3276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number103658
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0024380
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH28126
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: