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General NPI Number Information
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NPI Number | 1821480088
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Entity Type | Individual
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Provider Name | JESSICA MARIE BAUERLE
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Gender | Female
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 1001 E BAKER ST SUITE 100
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City | PLANT CITY
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State | FL
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Zip | 33563-3700
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Country | US
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Telephone | 813-754-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 E BAKER ST SUITE 100
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City | PLANT CITY
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State | FL
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Zip | 33563-3700
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Country | US
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Telephone | 813-754-5555
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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 | IMH 13258
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License Number State | FL
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