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General NPI Number Information
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NPI Number | 1851646137
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Entity Type | Individual
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Provider Name | JESSIKA CZVERENCZ DBH, LPC, LMFT
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Gender | Female
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 11/24/2024
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Provider Practice Location Address
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Address Line | 4949 TAMIAMI TRL N STE 202
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City | NAPLES
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State | FL
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Zip | 34103-3017
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Country | US
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Telephone | 303-386-6429
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Fax |
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Provider Business Mailing Address
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Address Line | 1668 SPOONBILL LN UNIT A
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City | NAPLES
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State | FL
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Zip | 34105-2887
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Country | US
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Telephone | 303-386-6429
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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 | MT3749
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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 | 0006522
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License Number State | CO
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