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General NPI Number Information
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NPI Number | 1588537153
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Entity Type | Organization
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Legal Business Name | JTLC COLLECTIVE LLC
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 62 NE 167TH ST SUITE 1113
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City | MIAMI
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State | FL
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Zip | 33162-3401
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Country | US
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Telephone | 586-840-8614
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Fax | 586-501-1664
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Provider Business Mailing Address
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Address Line | 62 NE 167TH ST
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City | MIAMI
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State | FL
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Zip | 33162-3401
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Country | US
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Telephone | 586-840-8614
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Fax | 586-501-1664
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Authorized Official
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Title or Position | MANAGER/CLINICAL THERAPIST
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Name | JENNIFER T LEWIS
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Credential | LMSW-C, LCSW, LICSW
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Telephone | 586-840-8614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101200000X
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Taxonomy Name | Drama Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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Taxonomy #4
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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Taxonomy #6
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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Taxonomy #8
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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Taxonomy #9
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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Taxonomy #10
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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Taxonomy #11
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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Taxonomy #13
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number |
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Taxonomy #14
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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Taxonomy #15
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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