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General NPI Number Information
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NPI Number | 1396033874
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Entity Type | Individual
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Provider Name | CARLOS ALBERTO JAZAN LMHC
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Gender | Male
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Dates
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Enumeration Date | 07/18/2011
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 4038 SANDY BLUFF DR W
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City | GULF BREEZE
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State | FL
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Zip | 32563-2938
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Country | US
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Telephone | 850-665-3599
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Fax | 850-665-3599
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Provider Business Mailing Address
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Address Line | PO BOX 838
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City | GULF BREEZE
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State | FL
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Zip | 32562-0838
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Country | US
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Telephone |
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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 | MH3744
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License Number State | FL
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