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General NPI Number Information
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NPI Number | 1487027884
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Entity Type | Individual
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Provider Name | JENNIFER FROM LMHC
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Gender | Female
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Dates
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Enumeration Date | 11/06/2015
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Last Update Date | 11/06/2015
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Provider Practice Location Address
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Address Line | 2140 N DON WICKHAM DR
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City | CLERMONT
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State | FL
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Zip | 34711-1923
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Country | US
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Telephone | 352-394-5922
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Fax | 352-315-7587
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Provider Business Mailing Address
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Address Line | 3599 CONROY RD UNIT 911
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City | ORLANDO
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State | FL
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Zip | 32839-2464
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Country | US
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Telephone | 321-287-6533
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Fax | 352-315-7587
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MH 13761
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License Number State | FL
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