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General NPI Number Information
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NPI Number | 1629774542
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Entity Type | Organization
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Legal Business Name | JEANIS HOLISTIC PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 02/02/2023
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Last Update Date | 02/02/2023
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Provider Practice Location Address
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Address Line | 331 NW 78TH TER APT 104
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-1219
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Country | US
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Telephone | 954-546-1093
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Fax | 954-827-0863
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Provider Business Mailing Address
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Address Line | 13173 SW 44TH ST
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City | MIRAMAR
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State | FL
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Zip | 33027-3114
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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 | CEO & CLINICAL THERAPIST
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Name | LAURA ARMIDE JEANIS
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Credential | MSW, LCSW
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Telephone | 754-280-8805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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