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General NPI Number Information
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NPI Number | 1942921366
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Entity Type | Organization
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Legal Business Name | COFFEE WITH JANE, PLLC
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Dates
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Enumeration Date | 09/05/2022
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 4591 E HIGHWAY 20 STE 202I
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City | NICEVILLE
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State | FL
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Zip | 32578-8845
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Country | US
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Telephone | 850-333-6828
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Fax | 850-254-9837
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Provider Business Mailing Address
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Address Line | 4516 E HIGHWAY 20 # 146
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City | NICEVILLE
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State | FL
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Zip | 32578-9755
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Country | US
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Telephone | 850-333-6828
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Fax | 850-254-9837
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Authorized Official
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Title or Position | OWNER
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Name | MS. JANE ELLEN DAVIS
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Credential | LCSW
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Telephone | 850-333-6828
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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 |
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License Number State |
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Taxonomy #2
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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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License Number State |
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Taxonomy #3
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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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