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General NPI Number Information
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NPI Number | 1093209751
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Entity Type | Organization
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Legal Business Name | JILL A. CANTRELL, LMHC, PA
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Dates
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Enumeration Date | 06/18/2018
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Last Update Date | 12/12/2019
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Provider Practice Location Address
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Address Line | 1006 W PLATT ST
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City | TAMPA
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State | FL
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Zip | 33606-2116
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Country | US
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Telephone | 813-505-3956
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Fax | 833-922-1072
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Provider Business Mailing Address
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Address Line | 5100 BURCHETTE RD UNIT 905
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City | TAMPA
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State | FL
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Zip | 33647-1060
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Country | US
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Telephone | 813-505-3956
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | JILL ANNE CANTRELL
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Credential | LMHC
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Telephone | 813-505-3956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH9928
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License Number State | FL
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