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General NPI Number Information
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NPI Number | 1457955437
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Entity Type | Individual
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Provider Name | JENNIFER ELAINE HAYNES LMHC
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Gender | Female
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 1995 SW NEWPORT ISLES BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-4382
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Country | US
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Telephone | 772-307-0050
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Fax |
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Provider Business Mailing Address
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Address Line | 1995 SW NEWPORT ISLES BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-4382
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Country | US
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Telephone | 772-877-5756
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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 | IMH20058
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH22103
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License Number State | FL
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