Healthcare Provider Details

I. General information

NPI: 1275737645
Provider Name (Legal Business Name): JENIE LIANG JONAS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6938 MEDICAL VIEW LN
ZEPHYRHILLS FL
33542-6602
US

IV. Provider business mailing address

6938 MEDICAL VIEW LN
ZEPHYRHILLS FL
33542-6602
US

V. Phone/Fax

Practice location:
  • Phone: 813-780-2550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY7431
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: