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General NPI Number Information
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NPI Number | 1346511300
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Entity Type | Individual
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Provider Name | JENNIFER NICOLE RECKLEY LMHC
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Gender | Female
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Dates
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Enumeration Date | 01/23/2012
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 110 E BROWARD BLVD SUITE 1700
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-3503
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Country | US
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Telephone | 954-242-2810
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Fax |
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Provider Business Mailing Address
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Address Line | 9148 NW 38TH PL
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City | SUNRISE
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State | FL
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Zip | 33351-8830
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Country | US
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Telephone | 954-242-2810
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH10721
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License Number State | FL
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