MEDICARE: ANGE-FENNIE JEAN 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	MT4454	FL
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1356622781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGE-FENNIE JEAN LMFT

Provider Business Mailing Address
First Line	:	14645 NW 77TH AVE STE 101
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2569
Country	:	US
Telephone Number	:	833-769-3524
Fax Number	:

Provider Business Practice Location Address
First Line	:	14645 NW 77TH AVE STE 101
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2569
Country	:	US
Telephone Number	:	833-769-3524
Fax Number	:

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

Provider Enumeration Date	:	08/30/2011
Last Update Date	:	11/12/2025

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Directions to “ ANGE-FENNIE JEAN LMFT” Practice Location

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