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General NPI Number Information
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NPI Number | 1093175879
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Entity Type | Individual
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Provider Name | JENNIFER SOUSA PMT
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Gender | Female
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 04/17/2018
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Provider Practice Location Address
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Address Line | 30 ROLLING SANDS DRIVE
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City | PALM COAST
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State | FL
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Zip | 32164
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Country | US
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Telephone | 508-971-0147
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Fax |
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Provider Business Mailing Address
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Address Line | 355 FAY WAY
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94043-2803
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Country | US
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Telephone | 508-971-0147
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 729
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | PMT175
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 83546
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License Number State | CA
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