MEDICARE: MRS. JENIFER JOHNSTON ELLIOTT LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MT2240	FL

General Provider Information

NPI Number	:	1194916270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENIFER JOHNSTON ELLIOTT LMFT

Provider Business Mailing Address
First Line	:	PO BOX 320284
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33679-2284
Country	:	US
Telephone Number	:	813-767-9358
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 S HOOVER BLVD
Second Line	:	SUITE 101
City	:	TAMPA
State	:	FL
Zip	:	33609-3540
Country	:	US
Telephone Number	:	813-767-9358
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	04/18/2013

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