Healthcare Provider Details

I. General information

NPI: 1194635540
Provider Name (Legal Business Name): JENNIFER WILSON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8451 TEMPLE TERRACE HWY
TEMPLE TERRACE FL
33637-5853
US

IV. Provider business mailing address

5933 CARINA TRCE
WESLEY CHAPEL FL
33545-4102
US

V. Phone/Fax

Practice location:
  • Phone: 813-801-3915
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH25550
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: