MEDICARE: JESSICA PARKER

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	IMH25378	FL
2	101YM0800X	Mental Health Counselor	MH27370	FL
3	101YM0800X	Mental Health Counselor		FL

General Provider Information

NPI Number	:	1235990003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA PARKER

Provider Business Mailing Address
First Line	:	429 ALAFAYA WOODS BLVD APT B
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-5513
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 MAITLAND AVE
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-6862
Country	:	US
Telephone Number	:	407-283-7240
Fax Number	:

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

Provider Enumeration Date	:	01/19/2024
Last Update Date	:	03/02/2026

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