MEDICARE: JEFFREY GLENN JABICK LMHC

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	101YM0800X	Mental Health Counselor	MH5458	FL

General Provider Information

NPI Number	:	1205986684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY GLENN JABICK LMHC

Provider Business Mailing Address
First Line	:	9715 W BROWARD BLVD # 148
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-2351
Country	:	US
Telephone Number	:	954-424-6119
Fax Number	:	954-585-0177

Provider Business Practice Location Address
First Line	:	7372 NW 5TH ST
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33317-1605
Country	:	US
Telephone Number	:	954-424-6119
Fax Number	:	954-585-0177

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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